This article is more than 5 years old. Information may no longer be current.
VMA does not affect visual acuity after anti-VEGF injections for polypoidal choroidal vasculopathy
Eyes with and without vitreomacular adhesion had considerable improvement in BCVA and central macular thickness.
Posterior vitreomacular adhesion was not associated with visual outcomes after intravitreal anti-VEGF therapy for polypoidal choroidal vasculopathy, according to a study.
“Although polypoidal choroidal vasculopathy (PCV) is considered to be a subtype of exudative age-related macular degeneration, the results of this study indicate that, unlike in typical AMD, posterior VMA is not a factor for visual results,” lead author Han Joo Cho, MD, said.
Cho said a few studies have reported that VMA plays an important role in the development of AMD and that some previous reports have described posterior VMA to be associated with an inferior visual outcome after intravitreal anti-VEGF treatment for exudative AMD.
“I wanted to determine whether VMA had an effect on anti-VEGF treatment for PCV,” he told Ocular Surgery News.
The study, a retrospective review of the medical records of 104 eyes of 102 patients published in Retina, categorized PCV patients undergoing anti-VEGF therapy into two groups, based on the presence of VMA: 23 eyes had VMA, and 81 eyes did not have VMA.
Han Joo Cho
VMA, which was examined by spectral-domain optical coherence tomography as part of routine eye examinations, was defined as adhesion of the posterior hyaloid membrane involving the center of the foveal region, with or without a hyper-reflection area on the inner surface of the retina.
At the final 12-month follow-up, the average number of Avastin (bevacizumab, Genentech) or Lucentis (ranibizumab, Genentech) injections was 4.82 in the VMA-positive group and 4.92 in the VMA-negative group.
Improved BCVA
Best corrected visual acuity improved from 20/129 to 20/91 in the VMA-positive group and from 20/123 to 20/91 in the VMA-negative group. Likewise, average central macular thickness (CMT) decreased from 354.4 µm to 249.6 µm and from 361.2 µm to 267.3 µm, respectively.
The polyp regression rate was also similar: 21.7% (five of 23 eyes) in the VMA-positive group and 22.2% (18 of 81 eyes) in the VMA-negative group.
“Twelve months after treatment, no statistically significant differences were observed in BCVA, CMT and the polyp regression rate between the two groups,” Cho said.
Both groups showed significant improvement from baseline and stability in BCVA and CMT over time. However, there was a loss of at least three lines of visual acuity in 17.4% (four of 23 eyes) in the VMA-positive group and 17.3% (14 of 81 eyes) in the VMA-negative group.
No complications
No complications associated with the intravitreal injections were observed during the course of the study.
“Surgeons planning a vitrectomy for AMD patients with VMA should take into consideration the fact that surgical or pharmacologic induction for [posterior vitreous detachment] will not be helpful in the treatment of PCV patients,” Cho said.
Compared with typical AMD, “PCV exhibits some differences with respect to the nature of choroidal neovascularization,” Cho said. “Because the abnormal vessels in PCV extend beneath the retinal pigment epithelium, and possibly into Bruch’s membrane, the changes in the vitreomacular interface have a lesser effect on PCV than on typical AMD.”
Currently, administration of anti-VEGF injection is the primary treatment for AMD. “Therefore, patient selection is critical before considering vitrectomy for AMD patients with VMA,” Cho said.
In the future, if pharmacologic vitreolysis agents such as Jetrea (ocriplasmin, ThromboGenics) are used more frequently to demonstrate their therapeutic effectiveness, anti-VEGF therapy in combination with a vitreolysis agent could be used as an effective treatment option for typical AMD with VMA, Cho said.
At Cho’s institution, a study to determine the relationship between PVD status and VMA and the effect of intravitreal ranibizumab injection on AMD treatment is currently under way. – by Bob Kronemyer