Title

VITREOMACULAR INTERFACE AFTER ANTI-VEGF INJECTIONS IN DIABETIC MACULAR EDEMA

Introduction

The purpose of this study is to evaluate the incidence of vitreomacular adhesion (VMA) release after anti-VEGF therapy for the treatment of diabetic macular edema (DME) and to evaluate further changes in outcome.

Methods

This is a retrospective study that enrolled 66 eyes of 66 patients with DME who presented with VMA by spectral-domain optical coherence tomography (OCT) at baseline. VMA was classified as focal (attachment: ≤ 1500 μm) or broad (attachment: > 1500 μm). All patients received at least three monthly intravitreal injections of an anti-VEGF agent. Follow-up visits were performed 1 month after each injection to evaluate the incidence of VMA release.

Results

The mean age was 61.4 years (range: 29 to 78 years) and 72.7% were male. Mean best-corrected visual acuity was 0.62 logMAR and mean central retinal thickness (CRT) was 473 μm at baseline. Mean follow-up was 18.5 months and the mean number of injections was 5.8. Intravitreal drugs used were aflibercept (40.9%), ranibizumab (37.9%) and bevacizumab (21.2%). Forty-seven eyes had broad VMA and 19 had focal VMA. Twenty-two eyes (33.3%) developed VMA release following a mean of 5.7 injections (range: 3-13). Sixteen eyes (72.7%) with focal VMA and 6 eyes (27.3%) with broad VMA at baseline developed VMA release. Twenty-one eyes that developed VMA release showed improvement in CRT following VMA release (mean: -106 μm; range: 22 to 289 μm).

Discussion

VMA release occurs in approximately 1/3 of the patients with DME following anti-VEGF therapy. Most of them showed short-term decrease in CRT.

Keywords

vitreomacular adhesion, diabetic retinopathy, vascular endothelial growth factor

Area

CLINICAL CASE

Authors

Carlos E Veloso, Daniel Nehemy Brocchi, Rishi P Singh, Marcio Bittar Nehemy