Título

VITREOMACULAR INTERFACE AFTER ANTI-VEGF INJECTIONS IN DIABETIC MACULAR EDEMA

Introdução / Purpose

To evaluate the incidence of vitreomacular adhesion (VMA) release after intravitreal injections of anti-VEGF agents and to measure the central retinal thickness (CRT) after this event in cases of diabetic macular edema (DME).

Material e Método / Methods

This is a prospective cohort study conducted at a single tertiary referral vitreoretinal practice. A total of 280 eyes of 196 patients were diagnosed with DME between 2010 and 2016. 74 eyes of 66 patients met the inclusion criteria and were evaluated in this study. This study included patients with DME who presented VMA detected by spectral-domain optical coherence tomography (OCT) at baseline. Eyes with VMA were classified according to the diameter of vitreous attachment to macular surface measured by OCT, with attachment of 1500 μm or less defined as focal and attachment of more than 1500 μm as broad. All patients were submitted to at least three monthly intravitreal injections of anti-VEGF agents. Follow-up visits were performed 1 month after each intravitreal injection and included OCT analysis to evaluate the incidence of VMA release.

Resultados / Results

Mean follow-up period was 18.5 months (range: 3 to 42 months). The mean number of intravitreal injections was 5.9 (range: 3 to 21 injections). Intravitreal drugs used in the study were: aflibercept (40.6%), ranibizumab (37.8%) and bevacizumab (21.6%). From 74 eyes with DME and VMA, 52 had broad VMA and 22 had focal VMA. A total of 24 eyes (32.4%) developed VMA release following intravitreal anti-VEGF injection and 50 eyes (62.2%) remained with persistent VMA. All eyes that developed VMA release showed improvement in CRT (mean: 96 μm; range: 2 to 289 μm). Seventeen eyes (70.8%) with focal VMA and 7 eyes (29.2%) with broad VMA at baseline developed VMA release.

Discussão e Conclusões / Discussion

VMA release occured in approximately one third of the patients with DME following intravitreal injections of anti-VEGF agents. Most of these patients showed significant short-term decrease in CRT.

Palavras Chave

vitreomacular adhesion; diabetic macular edema