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Y. Nomura, T. Ueta, A. Iriyama, Y. Inoue, R. Obata, H. Takahashi, Y. Yanagi, Y. Tamaki; Posterior Vitreomacular Adhesion in Exudative Aged-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5068.
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To compare the frequency of posterior vitreous detachment in two major forms of exudative aged-related macular degeneration (AMD) in Japanese patients, i.e., typical AMD and polypoidal choroidal vasculopathy (PCV).
This study is a prospective, observational case series. B-scan ultrasonography and optical coherence tomography (OCT) were performed in 293 eyes,81 eyes with typical AMD, 89 eyes with PCV and 123 control eyes. Main outcome measures were the number of eyes with complete posterior vitreous detachment (PVD) by ultrasonography and number of the eyes with persistent attachment of the posterior vitreous cortex, depicted as epiretinal membrane (ERM) or central vitreomacular adhesion by OCT. Additionally, the clinical courses of eyes which received PDT were investigated retrospectively.
By ultrasonography, 51 (63%) of the 81 eyes with typical AMD had complete PVD as compared with 58 (65%) of the 89 eyes with PCV and 82 (67%) of the 123 controls. Although statistically insignificant, there was a trend for typical AMD to have less complete PVD. OCT detected epiretinal membrane (ERM) and vitreomacular adhesion in 6 (8%) and 8 (11%) of the 73 eyes with typical AMD,in 4 (5%) and 9 (11%) of the 81 eyes with PCV, and in 6 (6%) and 13 (12%) of the 105 controls, respectively. There was a trend towards increased numbers of ERM of eyes with exudative AMD compared with those with PCV and controls. The eyes without PVD or the eyes with either ERM or vitreomacular adhesion tended to require more frequent retreatment sessions of PDT than the eyes without PVD and posterior vitreous attachment.
Complete PVD was less frequently and posterior vitreomacular adhesion was more frequently observed in the eyes with typical AMD than in those with PCV or the controls. The frequency, however, was less than in previous investigations, suggesting that attachment of the posterior vitreous cortex to the macular played minor role in the pathogenesis of AMD in the population. However, PDT may be less effective in the cases with persistent attachment of the posterior vitreous cortex to the macula.
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