Study: Hyaloid adhesion linked to AMD severity, may cause vitreomacular traction

Hyaloid adhesion occurs regularly in patients with age-related macular degeneration and may cause vitreomacular traction in eyes with choroidal neovascularization, a retrospective study suggests. In addition, these tractional forces may then trigger pharmacological resistance by antagonizing the effect of anti-VEGF treatment.

Francesca Mojana, MD, and colleagues at the University of California in San Diego performed combined spectral optical coherence tomography and scanning laser ophthalmoscopy on 170 eyes of 94 elderly patients. Specifically, 61 of these eyes had exudative AMD that had been unresponsive to anti-VEGF treatment, 59 eyes had nonexudative AMD, and 50 eyes had no AMD. The investigators than evaluated images for the presence of hyaloid adhesion to the posterior pole and for vitreomacular traction. In addition, best corrected visual acuity and retinal thickness were calculated. Study results were published in the August issue of American Journal of Ophthalmology.

The investigators identified hyaloid adhesion in 17 eyes (27.8%) with exudative AMD, 15 eyes (25.4%) with nonexudative AMD, and eight control eyes (16%); the difference between the three groups was significant (P = .002), the authors noted.

Among the 40 eyes with hyaloid adhesion, the investigators identified vitreomacular traction in 10 eyes (59%) with exudative AMD, two eyes (13%) with nonexudative AMD, and one control eye (12%), demonstrating a significant association between AMD severity and vitreomacular traction (P = .0082).

"The area of hyaloid adhesion was significantly smaller than and concentric to the area of CNV complex in eyes with exudative AMD," the authors said. Subsequently, five patients with vitreomacular traction who underwent surgical hyaloid removal demonstrated a small improvement in BCVA and a decrease in retinal thickness, the authors noted.