Posterior Vitreomacular Adhesion: A Potential Risk Factor for Exudative Age-related Macular Degeneration?

doi:10.1016/j.ajo.2007.07.024

American Journal of Ophthalmology

Volume 144, Issue 5, November 2007, Pages 741-746.e1

https://doi.org/10.1016/j.ajo.2007.07.024 Get rights and content

Purpose

To compare the state of the posterior vitreous in exudative age-related macular degeneration (AMD) with eyes with nonexudative AMD and controls.

Design

Prospective, observational case series.

Methods

B-scan ultrasonography and optical coherence tomography (OCT) were performed in 163 eyes from 82 subjects older than 55 years, 50 eyes with exudative AMD, 57 with nonexudative AMD, and 56 control eyes. Main outcome measures were the number of eyes with complete posterior vitreous detachment (PVD) by ultrasound and the number of eyes with central vitreomacular adhesion by OCT.

Results

By ultrasonography, 17 (34.0%) of 50 eyes with exudative AMD had PVD as compared with 41 (71.9%) of 57 eyes with nonexudative AMD (P = .00002) and 34 (60.7%) of 56 controls (P = .017). OCT detected persistent central vitreoretinal adhesion surrounded by a detached posterior vitreous cortex in 18 (36%) of 50 eyes with exudative AMD, significantly higher than in nonexudative AMD (4/57 [7%]; P < .0001) and in controls (6/56 [10%]; P = .002).

Conclusions

Persistent attachment of the posterior vitreous cortex to the macula may be another risk factor for the development of exudative AMD via vitreoretinal traction inducing chronic low-grade inflammation, by maintaining macular exposure to cytokines or free radicals in the vitreous gel, or by interfering in transvitreous oxygenation and nutrition of the macula. Inducing PVD may provide prophylactic benefit against exudative AMD.

Section snippets

Methods

In this prospective, comparative study, only patients 55 years of age or older were enrolled. Both eyes of a patient were included. Sufficient visualization of the retina by physical examination was required to provide useful quality for fluorescein angiography (FA) and OCT evaluation of the posterior segment. Eyes with evidence of neovascular AMD in FA were included in group 1 (exudative AMD), eyes with either pigmentary changes or drusen were included in group 2 (nonexudative AMD), and eyes

Demographic Data

In 163 eyes from 82 subjects older than 55 years of age, there were 50 eyes with exudative AMD, 57 with nonexudative AMD, and 56 control eyes. A total of 163 eyes in 82 subjects (one second eye could not be included because of subretinal surgery in that eye) were included. Sixty-one patients had the same pathologic features in both eyes (15 patients with exudative AMD, 21 patients with nonexudative AMD, and 25 controls), 14 patients had exudative AMD in one eye and nonexudative AMD in the

Discussion

Vitreous changes during aging have been described by Foos¹³ and Sebag.5, 6, 7 Age-related vitreous liquefaction in conjunction with weakening of vitreoretinal adhesion⁷ result in PVD. The incidence of PVD increases with age¹³ so that by the eighth decade, the risk of PVD was reported to be approximately 63%.¹³ However, our own observations during vitrectomy and submacular surgery in 66 eyes with exudative AMD (mean age, 77.8 years) showed that in 55 (83%) of 66 eyes, there was an attached

Ilse Krebs, MD, received her medical degree from the Vienna Medical University. Since 1986, she is senior physician at the Department of Ophthalmology, Rudolf Foundation Clinic in Vienna and since 1997, vice chairman of the Department of Ophthalmology, Rudolf Foundation Clinic. Dr Krebs areas of research interest are diagnosis and therapy of macular diseases including photodynamic therapy, anti-VEGF therapy, fluorescein angiography, optical coherence tomography, and she has published a series

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Original articlePosterior Vitreomacular Adhesion: A Potential Risk Factor for Exudative Age-related Macular Degeneration?

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Demographic Data

Discussion

Am J Ophthalmol

Jpn J Ophthalmol

Ophthalmology

Ophthalmology

Am J Ophthalmol

Surv Ophthalmol

Ophthalmology

Continuing medical education review: choroidal neovascularization in age-related macular degeneration—what is the cause?

Retina

Macular hole formation: new data provided by optical coherence tomography

Arch Ophthalmol

Perifoveal vitreous detachment and its macular complications

Trans Am Ophthalmol Soc

Vitreous—from biochemistry to clinical relevance

Age-related changes in human vitreous structure

Graefes Arch Clin Exp Ophthalmol

Age-related differences in the human vitreo-retinal interface

Arch Ophthalmol

[Incidence of posterior vitreous detachment in the elderly]

Ophthalmologe

The Age-Related Eye Disease Study severity scale for age-related macular degeneration: AREDS Report No. 17

Arch Ophthalmol

A simplified severity scale for age-related macular degeneration: AREDS Report No. 18

Arch Ophthalmol

Maximum likelihood estimation of misspecified models

Econometrica

Posterior vitreous detachment

Trans Am Acad Ophthalmol Otolaryngol

Original article
Posterior Vitreomacular Adhesion: A Potential Risk Factor for Exudative Age-related Macular Degeneration?