Impact of Vitreomacular Adhesion on Ranibizumab Mono- and Combination Therapy for Neovascular Age-Related Macular Degeneration

• Published in: American journal of ophthalmology Vol. 158; no. 2; pp. 328 - 336.e1
• Main Authors: Waldstein, Sebastian M, Ritter, Markus, Simader, Christian, Mayr-Sponer, Ulrike, Kundi, Michael, Schmidt-Erfurth, Ursula
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2014; Elsevier Limited
• Subjects: Adhesion; Aged; Antibodies, Monoclonal, Humanized - administration & dosage; Choroidal Neovascularization - complications; Choroidal Neovascularization - diagnosis; Choroidal Neovascularization - drug therapy; Clinical medicine; Clinical trials; Cysts; Diabetic retinopathy; Drug therapy; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Intravitreal Injections; Macula Lutea - drug effects; Macula Lutea - pathology; Macular degeneration; Macular Degeneration - complications; Macular Degeneration - diagnosis; Macular Degeneration - drug therapy; Male; Ophthalmology; Photochemotherapy - methods; Photosensitizing Agents - administration & dosage; Prospective Studies; Ranibizumab; Single-Blind Method; Studies; Time Factors; Tissue Adhesions; Tomography, Optical Coherence; Treatment Outcome; Vascular endothelial growth factor; Visual Acuity; Vitreous Body - drug effects; Vitreous Body - pathology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2014.04.028

Purpose To investigate the influence of vitreomacular adhesion on the efficacy of pro re nata (PRN) ranibizumab monotherapy and verteporfin photodynamic therapy (PDT) combination therapy for neovascular age-related macular degeneration. Design Post hoc analysis of prospective randomized 12-month multicenter clinical trial data. Methods patient population : Total of 255 treatment-naïve patients with subfoveal choroidal neovascularization. observation procedure : Assessment of the vitreomacular interface on monthly optical coherence tomography with division of patients into the following categories according to continuous 1-year grading: posterior vitreous detachment (n = 154), dynamic release of vitreomacular adhesion (n = 32), stable vitreomacular adhesion (n = 51). main outcome measures : Mean best-corrected visual acuity (BCVA) letter and central retinal thickness changes at month 12 in the vitreomacular interface groups. Results Mean BCVA changes at month 12 were +3.5 (posterior vitreous detachment), +4.3 (release of vitreomacular adhesion), and +6.3 (vitreomacular adhesion) in patients receiving monotherapy ( P  = .767), and +0.1 (posterior vitreous detachment), +6.6 (release of vitreomacular adhesion), and +9.2 (vitreomacular adhesion) in patients receiving combination therapy ( P  = .009). Mean central retinal thickness changes were −113 μm (posterior vitreous detachment), −89 μm (release of vitreomacular adhesion), and −122 μm (vitreomacular adhesion) in monotherapy ( P  = .725) and −121 μm (posterior vitreous detachment), −113 μm (release of vitreomacular adhesion), and −113 μm (vitreomacular adhesion) in combination therapy ( P  = .924). Mean ranibizumab retreatments during 12 months were 4.9 (posterior vitreous detachment), 6.6 (release of vitreomacular adhesion), and 5.3 (vitreomacular adhesion) in monotherapy ( P  = .018) and 4.7 (posterior vitreous detachment), 5.2 (release of vitreomacular adhesion), and 5.8 (vitreomacular adhesion) in combination therapy ( P  = .942). Conclusion This study adds evidence that the vitreomacular interface status impacts functional outcomes and retreatment requirements. Patients with posterior vitreous detachment achieve acceptable results with fewer injections in PRN monotherapy, but lose potential vision gain with PDT. Patients with other vitreomacular interface configurations may potentially achieve optimized vision outcomes by combination of antiangiogenic treatment and vaso-occlusive PDT.