Original article
Posterior Vitreomacular Adhesion and Risk of Exudative Age-related Macular Degeneration: Paired Eye Study

https://doi.org/10.1016/j.ajo.2008.10.003Get rights and content

Purpose

To evaluate posterior vitreomacular adhesion as a risk factor for choroidal neovascularization (CNV) in age-related macular degeneration (AMD).

Design

Retrospective, observational case series.

Methods

We retrospectively reviewed optical coherence tomography (OCT) and fluorescein angiography (FA) of 251 consecutive patients with unilateral exudative AMD. Fellow eyes had no sign of exudative AMD. Vitreomacular adhesion was defined when posterior hyaloid line attached to inner retinal surface was seen in OCT. We compared the incidence of posterior vitreomacular adhesion between the 2 eyes and the association between CNV location and vitreomacular adhesion.

Results

We found posterior vitreomacular adhesion in 56 patients (22.3%), and 3 cases in which it was present in both eyes. CNV was mostly present in eyes with vitreomacular adhesion (44/53, 83%), and rarely found in eyes without vitreomacular adhesion (6/53, 11.3%; P = .0007). The location of vitreomacular adhesion was always observed over the area of the CNV in exudative eyes (50/50).

Conclusions

Posterior vitreomacular adhesion is associated with CNV in AMD. Chronic vitreomacular traction may be a risk factor for the development of exudative AMD.

Section snippets

Methods

We retrospectively reviewed data for consecutive patients who were diagnosed with unilateral exudative AMD at the vitreoretinal service clinic of the Yonsei University Eye and Ear, Nose, and Throat Hospital, Seoul, Korea from October 1, 2005 to December 31, 2007.

We used the hospital clinical database (CDR software; Yonsei University Severance Hospital, Seoul, Korea) to identify patients with AMD who had bilateral OCT examination. Data were abstracted from the consecutive charts of 503 patients.

Results

We included 502 eyes from 251 consecutive patients with unilateral exudative AMD. The fellow eyes had dry AMD in 182 patients and no sign of AMD in 69 patients. A total of 143 patients were men and 108 were women. Patient age ranged from 50 to 93 years (mean ± standard deviation [SD], 68.4 ± 8.11 years). Forty-three patients had diabetes mellitus and 82 had hypertension.

Optical coherence tomography analysis indicated posterior vitreomacular adhesion in at least 1 eye of 56 patients (22.3%).

Discussion

We are unaware of any previous paired eye studies that examined the association between vitreomacular adhesion and CNV. Our results indicate that exudative AMD eyes had a significantly higher incidence of posterior vitreomacular adhesion than fellow eyes that did not have exudative AMD. These results are consistent with previously published research.4, 5, 9 However, attributable to nonpaired eye design of the previous studies, confounding variables (eg, genetic factors, environmental factors,

Sung Jun Lee, MD, graduated from the Yonsei University College of Medicine, Seoul, Korea in 1999. In 2004, he completed his residency at the Department of Ophthalmology of the same university. He worked as a research fellow at Mayo Clinic, Rochester, Minnesota in 2007. Since then, he started a fellowship at Yonsei University. Dr Lee's areas of research interest are diagnosis and therapy of macular degeneration including anti-VEGF treatment and optical coherence tomography.

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    Citation Excerpt :

    The prevalence of VMA was compared between the 2 eyes. As seen in previous studies,11,12 this analysis has the advantage to obviate the influence of confounding variables, such as demographic differences, age, gender, genetic factors, and environmental factors, including smoking, diet, and body mass index. Eyes with exudative AMD were evaluated for further analysis, as reported.

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Sung Jun Lee, MD, graduated from the Yonsei University College of Medicine, Seoul, Korea in 1999. In 2004, he completed his residency at the Department of Ophthalmology of the same university. He worked as a research fellow at Mayo Clinic, Rochester, Minnesota in 2007. Since then, he started a fellowship at Yonsei University. Dr Lee's areas of research interest are diagnosis and therapy of macular degeneration including anti-VEGF treatment and optical coherence tomography.

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