Effects of vitreomacular adhesion on anti-vascular endothelial growth factor treatment for exudative age-related macular degeneration

Objective: To evaluate the effect of posterior vitreomacular adhesion (VMA), documented by optical coherence tomography (OCT), on the outcome of anti-vascular endothelial growth factor (VEGF) treatment for exudative age-related macular degeneration (AMD).

Design: Retrospective comparative series.

Participants: A total of 148 patients (148 eyes) who were newly diagnosed with exudative AMD and were treated by anti-VEGF in 1 eye from 2005 to 2008 with a minimum of 12 months follow-up.

Methods: We retrospectively reviewed OCT and medical records of 148 patients with exudative AMD and categorized them according to the presence of posterior VMA into 2 subgroups: VMA (+) group (38 eyes) and VMA (-) group (110 eyes). Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) after anti-VEGF treatment were compared between the 2 groups at baseline; at 1, 3, 6, and 12 months; and at the last visit (mean = 21 months).

Main outcome measures: Mean changes in BCVA, which was converted to logarithm of the minimum angle of resolution (logMAR) values and CRT after anti-VEGF treatment.

Results: Mean BCVA significantly decreased over time in the VMA (+) group compared with the VMA (-) group (P = 0.039). At the last follow-up, mean BCVA had deteriorated from 0.87 logMAR (20/149 Snellen equivalent; baseline) to 0.98 logMAR (20/189 Snellen equivalent) in the VMA (+) group, but improved from 0.82 logMAR (20/132 Snellen equivalent, baseline) to 0.72 logMAR (20/104, Snellen equivalent) in the VMA (-) group (P = 0.028). In paired comparisons of BCVA between baseline and each follow-up visit, the VMA (-) group showed significant improvement of BCVA at every follow-up visit (P < 0.05); however, the VMA (+) group did not show significant visual improvement at any follow-up visit despite anti-VEGF treatment (P > 0.05). Comparison of mean CRT between baseline and each follow-up visit showed a statistically significant decrease at every follow-up in both groups (P < 0.05).

Conclusions: Posterior VMA was associated with an inferior visual outcome after intravitreal anti-VEGF treatment for exudative AMD. Our results suggest that chronic tractional forces may antagonize the effect of anti-VEGF treatment, resulting in poor response to anti-VEGF treatment with patients with VMA.