Abstract
Purpose :
To evaluate the influence of vitreomacular interface configuration on treatment outcomes after intravitreal anti-vascualr endothelial growth factor (anti-VEGF) therapy for exudative age-related macular degeneration (AMD).
Methods :
The Pubmed, EMBASE and Cochrane Central Register of Controlled Trials databases were searched to identify relevant prospective or retrospective studies that evaluate the influence of vitreomacular adhesion (VMA) or vitreomacular traction (VMT) on functional and anatomical outcomes in neovascular AMD patients treated with anti-VEGF agents. The outcome measures were the mean change in best corrected visual acuity (BCVA) from baseline, the mean change in central macular thickness (CMT) from baseline and the mean injection numbers of anti-VEGF treatment from baseline.
Results :
Ten studies were selected for this meta-analysis, including 2249 eyes (434 eyes in VMA/VMT group and 1815 eyes in non-VMA/VMT group). In neovascular AMD patients treated with anti-VEGF agents, VMA/VMT group was associated with poorer visual acuity gains and CMT reductions (mean difference [MD] =-5.32, 95% confidence interval [CI] = -10.17 to -0.47, P=0.03; mean difference [MD] =21.04, 95% confidence interval [CI] = 2.22 to 39.86, P=0.03, respectively). There was no significant difference in the mean injection numbers between two groups at 1 year (mean difference [MD] =0.17, 95% confidence interval [CI] = -0.42 to 0.75, P=0.57), whereas VMA/VMT group had a significantly higher mean injection numbers over 2 years or more (mean difference [MD] =0.74, 95% confidence interval [CI] = -0.02 to 1.45, P=0.04).
Conclusions :
The limited evidence suggests that vitreomacular interface configuration have a significant influence on the visual outcomes, CMT reduction and long-term injection numbers in neovascular AMD patients treated with anti-VEGF agents. However, the results of this meta-analysis should be interpreted with caution because of the heterogeneity among study designs. Eyes with VMA/VMT on optical coherence tomography at baseline may require more intensive treatment with decreased response to anti-VEGF agents.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.