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Number of anti-VEGF injections does not affect rate of macular hole development

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Lisa J. Faia

WAIKOLOA, Hawaii — The number of anti-VEGF injections given to patients with neovascular age-related macular degeneration did not appear to increase the rate of macular hole formation, according to a study presented here.

“I am a very aggressive injector,” Lisa J. Faia, MD, said at Retina 2019. “I didn’t want to be causing other problems.”

Because of that concern and knowing that prevalence of macular holes in neovascular AMD ranges from 1.9% to 5%, Faia undertook a study to assess whether surgical intervention in cases of macular hole in wet and dry AMD would make a difference in visual acuity and hole closure outcomes.

“Patients can have more than just AMD in their eye. If they also have macular hole, what difference does it make if you do surgical intervention or not?” she asked.

The retrospective, single-center chart review looked at 12,716 patients with neovascular AMD and 15,196 patients with non-neovascular AMD. A total of 199 eyes (0.7%) developed macular hole, which is a proportion similar to that seen in idiopathic cases in patients without AMD, according to Faia. Of these, 39 eyes with wet AMD (0.3%) and 160 with dry AMD (1%) developed a macular hole. For eyes with wet AMD, the mean number of injections before diagnosis of macular hole was 2.4.

A total of 104 eyes that developed macular hole (81.8%) went on to surgery and underwent internal limiting membrane peel. Final closure rate after surgical management in both groups was 89.8%, but there was a difference between the two. For wet AMD, closure rate was 81%; for dry AMD, closure rate was 91.5%.

Visual acuity results in eyes that underwent surgery showed no statistical difference in eyes with wet AMD, but there was a statistical difference in eyes with dry AMD (P < .001).

Even though closure rates were similar in both groups, visual outcomes were better in patients with non-neovascular AMD with macular hole who underwent surgery than in their counterparts with neovascular AMD. – by Patricia Nale, ELS

Reference: Faia LJ. Management of macular holes in age-related macular degeneration. Presented at: Retina 2019; Jan. 20-25, 2019; Waikoloa, Hawaii.

Disclosures: Faia reports no relevant financial disclosures.