Vitreomacular Interface after Anti-Vascular Endothelial Growth Factor Injections in Neovascular Age-Related Macular Degeneration

Abstract

Purpose: To evaluate the incidence of posterior vitreous detachment (PVD) induced by intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents in cases of neovascular age-related macular degeneration (AMD).

Design: Cohort study conducted at a single tertiary referral vitreoretinal practice.

Participants: A total of 396 eyes of 295 patients were diagnosed with neovascular AMD between 2009 and 2014. A total of 125 eyes of 112 patients met the inclusion criteria and were evaluated in this study.

Methods: This study included patients with neovascular AMD who presented vitreomacular adhesion (VMA) detected by spectral-domain optical coherence tomography (OCT) at baseline. Eyes with VMA were classified according to the diameter of vitreous attachment to the macular surface measured by OCT, with attachment of ≤1500 μm defined as focal and attachment of >1500 μm defined as broad. All patients received at least 3 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 PVD.

Main outcome measures: Posterior vitreous detachment induced by anti-VEGF injections.

Results: The mean follow-up period was 21.3 months (range, 3-59 months). The mean number of intravitreal injections was 8.3 (range, 3-29 injections). Intravitreal drugs used in the study were ranibizumab (51.5%), bevacizumab (33.5%), and aflibercept (15.0%). Seven eyes (5.6%) developed PVD after intravitreal drug injection (3 eyes after the first intravitreal injection: bevacizumab in 1 and ranibizumab in 2; 2 eyes after the second injection: ranibizumab in 1 and bevacizumab in 1; 1 eye after the fourth injection: ranibizumab; and 1 eye after the sixth injection: aflibercept). A total of 118 eyes remained with persistent VMA. All 7 eyes that developed PVD were classified as having focal VMA, with the diameter of vitreous attachment ranging from 210 to 1146 μm (mean, 600 μm).

Conclusions: Intravitreal injections of commonly used anti-VEGF intravitreal drugs rarely induce PVD in patients with neovascular AMD. Eyes with focal VMA have a greater chance to develop PVD than eyes with a broad area of VMA.