Effect on the vitreomacular interface after repeated anti-vascular endothelial growth factor treatment in patients with exudative age-related macular degeneration_Chinese Journal of Ocular Fundus Diseases

Authors：

Dong Qi , Hua Yingbin ,  Xu Haifeng

Qingdao Eye Hospital, Shandong Eye Institute, Qingdao 266071, China (Dong Qi, postgraduate student in Medical College of Qingdao University);

Corresponding author：

Xu Haifeng, Email: chxhf@126.com

Keywords：

Angiogenesis inhibitors/adverse effects; Wet macular degeneration; Vitreomacular interface

DOI：

10.3760/cma.j.issn.1005-1015.2018.03.013

Video：

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ObjectiveTo observe the effects of repeated intravitreal injections of anti-vascular endothelial growth factor (VEGF) drugs on vitreous macular interface (VMI) in patients with exudative age-related macular degeneration (AMD).MethodsRetrospective study. Thirty-four exudative AMD patients who treated with intravitreal anti-VEGF drugs were included in this study. There were 26 males and 8 females. The age ranged from 50 to 80 years, with the average of (62.8±8.35) years. The eyes with at least 6 treatments during the 1-year follow-up were taken as the study eyes, and the eyes with no anti-VEGF drug treatment were the control eyes. Optical coherence tomography (OCT) examination was used to observe the VMI status of both eyes before treatment. Vitreous macular adhesion (VMA), macular epiretinal membrane (MEM), and complete vitreous detachment (C-PVD) were defined as abnormalities in VMI. The VMA was classified as focal (≤1500 μm) and broad (＞1500 μm) depending on the diameter of the vitreous and macular adhesions on the OCT images. Before treatment, there were 12 eyes with abnormal VMI in study eyes, including 8 eyes with broad VMA, 3 eyes with focal VMA, and 1 eye with MEM; 12 eyes with abnormal VMI in control eyes: broad VMA in 7 eyes, focal VMA in 2 eyes, C-PVD in 2 eyes, and MEM in 1 eye. The average follow-up time after treatment was 16.4 months. During the follow-up period, OCT was performed monthly in a follow-up mode. Comparing the changes on VMI between before and after treatment in both eyes of patients, respectively. The chi-square test was used to compare the difference on VMI. Because the number of samples was ＜40, Fisher's exact test was used for the analysis.ResultsAt the final follow-up, 12 eyes with abnormal VMI in the study eyes, including 5 eyes with broad VMA, 2 eyes with focal VMA, 3 eyes with C-PVD, and 2 eyes with MEM. There were 6 eyes altered comparing with baseline. In the control eyes, there were 13 eyes with abnormal VMI, including 5 eyes with broad VMA, 7 eyes with C-PVD, and 1 eye with MEM. A total of 6 eyes changed on VMI comparing with baseline. At the final follow-up, there was no significant difference on VMI changes between the study eyes and its corresponding control eyes (P=0.053). In all eyes, a total of 4 eyes changed from focal VMA to C-PVD at the final follow-up, accounting for 80.0% of the total focal VMA; 3 eyes changed from broad VMA to C-PVD, accounting for 21.4% of the total broad VMA.ConclusionsRepeated anti-VEGF treatment has little effect on VMI. Regardless of anti-VEGF therapy, eyes with focal VMA appears to be more prone to C-PVD than the broad one.

Citation： Dong Qi, Hua Yingbin, Xu Haifeng. Effect on the vitreomacular interface after repeated anti-vascular endothelial growth factor treatment in patients with exudative age-related macular degeneration. Chinese Journal of Ocular Fundus Diseases, 2018, 34(3): 263-267. doi: 10.3760/cma.j.issn.1005-1015.2018.03.013 Copy

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2.	Brown DM, Michels M, Kaiser PK, et al. Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: two-year results of the ANCHOR study [J]. Ophthalmology, 2009, 116(1): 57-65. DOI: 10.1016/j.ophtha.2008.10.018.
3.	Kaiser PK, Blodi BA, Shapiro H, et al. Angiographic and optical coherence tomographic results of the MARINA study of ranibizumab in neovascular age-related macular degeneration [J]. Ophthalmology, 2007, 114(10): 1868-1875. DOI: 10.1016/j.ophtha.2007.04.030.
4.	Comparison of Age-Related Macular Degeneration Treatments Trials Research G, Martin DF, Maguire MG, et al. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results [J]. Ophthalmology, 2012, 119(7): 1388-1398. DOI: 10.1016/j.ophtha.2012.03.053.
5.	Lalwani GA, Rosenfeld PJ, Fung AE, et al. A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO Study [J]. Am J Ophthalmol, 2009, 148(1): 43-58. DOI: 10.1016/j.ajo.2009.01.024.
6.	Ho AC, Busbee BG, Regillo CD, et al. Twenty-four-month efficacy and safety of 0.5 mg or 2.0 mg ranibizumab in patients with subfoveal neovascular age-related macular degeneration [J]. Ophthalmology, 2014, 121(11): 2181-2192. DOI: 10.1016/j.ophtha.2014.05.009.
7.	Zhu M, Chew JK, Broadhead GK, et al. Intravitreal ranibizumab for neovascular age-related macular degeneration in clinical practice: five-year treatment outcomes [J]. Graefe's Arch Clin Exp Ophthalmol, 2015, 253(8): 1217-1225. DOI: 10.1007/s00417-014-2799-8.
8.	Boyer DS, Heier JS, Brown DM, et al. A Phase Ⅲb study to evaluate the safety of ranibizumab in subjects with neovascular age-related macular degeneration [J]. Ophthalmology, 2009, 116(9): 1731-1739. DOI: 10.1016/j.ophtha.2009.05.024.
9.	Chavan R, Panneerselvam S, Adhana P, et al. Bilateral visual outcomes and service utilization of patients treated for 3 years with ranibizumab for neovascular age-related macular degeneration [J]. Clin Ophthalmol, 2014, 8: 717-723. DOI: 10.2147/OPTH.S60763.
10.	Holz FG, Tadayoni R, Beatty S, et al. Multi-country real-life experience of anti-vascular endothelial growth factor therapy for wet age-related macular degeneration [J]. Br J Ophthalmol, 2015, 99(2): 220-226. DOI: 10.1136/bjophthalmol-2014-305327.
11.	Mojana F, Cheng L, Bartsch DU, et al. The role of abnormal vitreomacular adhesion in age-related macular degeneration: spectral optical coherence tomography and surgical results [J]. Am J Ophthalmology, 2008, 146(2): 218-227. DOI: 10.1016/j.ajo.2008.04.027.
12.	Nomura Y, Takahashi H, Tan X, et al. Effects of vitreomacular adhesion on ranibizumab treatment in Japanese patients with age-related macular degeneration [J]. Jpn J Ophthalmol, 2014, 58(5): 443-447. DOI: 10.1007/s10384-014-0333-5.
13.	Lee SJ, Lee CS, Koh HJ. Posterior vitreomacular adhesion and risk of exudative age-related macular degeneration: paired eye study [J]. Am J Ophthalmol, 2009, 147(4): 621-626 e1. DOI: 10.1016/j.ajo.2008.10.003.
14.	Schulze S, Hoerle S, Mennel S, et al. Vitreomacular traction and exudative age-related macular degeneration[J]. Acta Ophthalmol, 2008, 86(5): 470-481. DOI: 10.1111/j.1755-3768. 2008.01210.x.
15.	Krebs I, Brannath W, Glittenberg C, et al. Posterior vitreomacular adhesion: a potential risk factor for exudative age-related macular degeneration? [J]. Am J Ophthalmol, 2007, 144(5): 741-746. DOI: 10.1016/j.ajo.2007.07.024.
16.	Robison CD, Krebs I, Binder S, et al. Vitreomacular adhesion in active and end-stage age-related macular degeneration [J]. Am J Ophthalmol, 2009, 148(1): 79-82. DOI: 10.1016/j.ajo.2009.01.014.
17.	Duker JS, Kaiser PK, Binder S, et al. The international vitreomacular traction study group classification of vitreomacular adhesion, traction, and macular hole [J]. Ophthalmology, 2013, 120(12): 2611-2619. DOI: 10.1016/j.ophtha.2013.07.042.
18.	Suh MH, Seo JM, Park KH, et al. Associations between macular findings by optical coherence tomography and visual outcomes after epiretinal membrane removal [J]. Am J Ophthalmol, 2009, 147(3): 473-480. DOI: 10.1016/j.ajo.2008.09.020.
19.	Kakehashi A, Takezawa M, Akiba J. Classification of posterior vitreous detachment [J]. Clini Ophthalmol, 2014, 8: 1-10. DOI: 10.2147/OPTH.S54021.
20.	Uchino E, Uemura A, Ohba N. Initial stages of posterior vitreous detachment in healthy eyes of older persons evaluated by optical coherence tomography [J]. Arch Ophthalmol, 2001, 119(10): 1475-1479. DOI: 10.1001/archopht.119.10.1475.
21.	Johnson MW. Perifoveal vitreous detachment and its macular complications [J]. Trans Am Ophthalmol Soc, 2005, 103: 537-567.
22.	Veloso CE, Kanadani TM, Pereira FB, et al. Vitreomacular interface after anti-vascular endothelial growth factor injections in neovascular age-related macular degeneration [J]. Ophthalmology, 2015, 122(8): 1569-1572. DOI: 10.1016/j.ophtha.2015.04.028.
23.	Stalmans P, Benz MS, Gandorfer A, et al. Enzymatic vitreolysis with ocriplasmin for vitreomacular traction and macular holes [J]. N Engl J Med, 2012, 367(7): 606-615. DOI: 10.1056/NEJMoa1110823.

1. Rosenfeld PJ, Brown DM, Heier JS, et al. Ranibizumab for neovascular age-related macular degeneration [J]. N Engl J Med, 2006, 355(14): 1419-1431. DOI: 10.1056/NEJMoa054481.
2. Brown DM, Michels M, Kaiser PK, et al. Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: two-year results of the ANCHOR study [J]. Ophthalmology, 2009, 116(1): 57-65. DOI: 10.1016/j.ophtha.2008.10.018.
3. Kaiser PK, Blodi BA, Shapiro H, et al. Angiographic and optical coherence tomographic results of the MARINA study of ranibizumab in neovascular age-related macular degeneration [J]. Ophthalmology, 2007, 114(10): 1868-1875. DOI: 10.1016/j.ophtha.2007.04.030.
4. Comparison of Age-Related Macular Degeneration Treatments Trials Research G, Martin DF, Maguire MG, et al. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results [J]. Ophthalmology, 2012, 119(7): 1388-1398. DOI: 10.1016/j.ophtha.2012.03.053.
5. Lalwani GA, Rosenfeld PJ, Fung AE, et al. A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO Study [J]. Am J Ophthalmol, 2009, 148(1): 43-58. DOI: 10.1016/j.ajo.2009.01.024.
6. Ho AC, Busbee BG, Regillo CD, et al. Twenty-four-month efficacy and safety of 0.5 mg or 2.0 mg ranibizumab in patients with subfoveal neovascular age-related macular degeneration [J]. Ophthalmology, 2014, 121(11): 2181-2192. DOI: 10.1016/j.ophtha.2014.05.009.
7. Zhu M, Chew JK, Broadhead GK, et al. Intravitreal ranibizumab for neovascular age-related macular degeneration in clinical practice: five-year treatment outcomes [J]. Graefe's Arch Clin Exp Ophthalmol, 2015, 253(8): 1217-1225. DOI: 10.1007/s00417-014-2799-8.
8. Boyer DS, Heier JS, Brown DM, et al. A Phase Ⅲb study to evaluate the safety of ranibizumab in subjects with neovascular age-related macular degeneration [J]. Ophthalmology, 2009, 116(9): 1731-1739. DOI: 10.1016/j.ophtha.2009.05.024.
9. Chavan R, Panneerselvam S, Adhana P, et al. Bilateral visual outcomes and service utilization of patients treated for 3 years with ranibizumab for neovascular age-related macular degeneration [J]. Clin Ophthalmol, 2014, 8: 717-723. DOI: 10.2147/OPTH.S60763.
10. Holz FG, Tadayoni R, Beatty S, et al. Multi-country real-life experience of anti-vascular endothelial growth factor therapy for wet age-related macular degeneration [J]. Br J Ophthalmol, 2015, 99(2): 220-226. DOI: 10.1136/bjophthalmol-2014-305327.
11. Mojana F, Cheng L, Bartsch DU, et al. The role of abnormal vitreomacular adhesion in age-related macular degeneration: spectral optical coherence tomography and surgical results [J]. Am J Ophthalmology, 2008, 146(2): 218-227. DOI: 10.1016/j.ajo.2008.04.027.
12. Nomura Y, Takahashi H, Tan X, et al. Effects of vitreomacular adhesion on ranibizumab treatment in Japanese patients with age-related macular degeneration [J]. Jpn J Ophthalmol, 2014, 58(5): 443-447. DOI: 10.1007/s10384-014-0333-5.
13. Lee SJ, Lee CS, Koh HJ. Posterior vitreomacular adhesion and risk of exudative age-related macular degeneration: paired eye study [J]. Am J Ophthalmol, 2009, 147(4): 621-626 e1. DOI: 10.1016/j.ajo.2008.10.003.
14. Schulze S, Hoerle S, Mennel S, et al. Vitreomacular traction and exudative age-related macular degeneration[J]. Acta Ophthalmol, 2008, 86(5): 470-481. DOI: 10.1111/j.1755-3768. 2008.01210.x.
15. Krebs I, Brannath W, Glittenberg C, et al. Posterior vitreomacular adhesion: a potential risk factor for exudative age-related macular degeneration? [J]. Am J Ophthalmol, 2007, 144(5): 741-746. DOI: 10.1016/j.ajo.2007.07.024.
16. Robison CD, Krebs I, Binder S, et al. Vitreomacular adhesion in active and end-stage age-related macular degeneration [J]. Am J Ophthalmol, 2009, 148(1): 79-82. DOI: 10.1016/j.ajo.2009.01.014.
17. Duker JS, Kaiser PK, Binder S, et al. The international vitreomacular traction study group classification of vitreomacular adhesion, traction, and macular hole [J]. Ophthalmology, 2013, 120(12): 2611-2619. DOI: 10.1016/j.ophtha.2013.07.042.
18. Suh MH, Seo JM, Park KH, et al. Associations between macular findings by optical coherence tomography and visual outcomes after epiretinal membrane removal [J]. Am J Ophthalmol, 2009, 147(3): 473-480. DOI: 10.1016/j.ajo.2008.09.020.
19. Kakehashi A, Takezawa M, Akiba J. Classification of posterior vitreous detachment [J]. Clini Ophthalmol, 2014, 8: 1-10. DOI: 10.2147/OPTH.S54021.
20. Uchino E, Uemura A, Ohba N. Initial stages of posterior vitreous detachment in healthy eyes of older persons evaluated by optical coherence tomography [J]. Arch Ophthalmol, 2001, 119(10): 1475-1479. DOI: 10.1001/archopht.119.10.1475.
21. Johnson MW. Perifoveal vitreous detachment and its macular complications [J]. Trans Am Ophthalmol Soc, 2005, 103: 537-567.
22. Veloso CE, Kanadani TM, Pereira FB, et al. Vitreomacular interface after anti-vascular endothelial growth factor injections in neovascular age-related macular degeneration [J]. Ophthalmology, 2015, 122(8): 1569-1572. DOI: 10.1016/j.ophtha.2015.04.028.
23. Stalmans P, Benz MS, Gandorfer A, et al. Enzymatic vitreolysis with ocriplasmin for vitreomacular traction and macular holes [J]. N Engl J Med, 2012, 367(7): 606-615. DOI: 10.1056/NEJMoa1110823.

Chinese Journal of Ocular Fundus Diseases

Effect on the vitreomacular interface after repeated anti-vascular endothelial growth factor treatment in patients with exudative age-related macular degeneration

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