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F. Mojana, L. Cheng, D.-U. G. Bartsch, G. A. Silva, I. Kozak, N. Nigam, W. R. Freeman; Abnormal Vitreoretinal Interface in Age-Related Macular Degeneration: A Spectral OCT Study and Preliminary Surgical Outcomes. Invest. Ophthalmol. Vis. Sci. 2008;49(13):260.
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To assess the incidence of vitreomacular adhesion and traction in age-related macular degeneration (AMD), and to evaluate surgical treatment in a subset of patients with choroidal neovascularization (CNV) non-responsive to anti-neovascular growth factor (anti-VEGF) treatment.
Spectral Optical Coherence Tomography, combined with simultaneous Scanning Laser Ophthalmoscope (SpectralOCT/SLO), was performed in 170 eyes of 94 elder patients, 61 with exudative AMD, 59 with non-exudative AMD, 50 control eyes. The presence of hyaloid adhesion to the posterior pole, and vitreomacular traction (VMT) were determined. Five patients with VMT underwent surgical hyaloid removal. Best-corrected visual acuity (BCVA) and retinal thickness were evaluated as outcomes.
Hyaloid adhesion was present in 17 eyes with exudative AMD (27.8%), 15 eyes with non-exudative AMD (25.4%), and 8 control eyes (16%). Significant difference was found among the groups (p=0.001). VMT was associated with the severity of AMD (p=0.0082). The area of hyaloid adhesion was significantly smaller than and concentric to the area of CNV complex in eyes with exudative AMD. Eyes with VMT that underwent surgery experienced a significant improvement of BCVA (mean 1.4 +/- 1.14 ETDRS lines; p=0.026) and decrease of retinal thickness (mean -376 +/- 382 microns; p=0.046).
Hyaloid adhesion to the macula is highly associated with AMD, and frequently causes VMT in eyes with CNV. Tractional forces may antagonize the effect of anti-VEGF treatment, and cause pharmacological resistance in a subpopulation of patients. In these cases, surgery may be considered as a possible treatment option. Spectral-OCT/SLO allows careful diagnosis and follow-up.
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