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    VMA associated with poor outcomes in anti-VEGF-treated patients

    Dr. NehemyThe presence of vitreomacular adhesion (VMA) is associated with poorer, short-term anatomic, and functional outcomes in eyes with diabetic macular edema (DME) receiving anti-VEGF therapy, according to Márcio B. Nehemy, MD, PhD.

    “We know that anti-VEGF injections can be an effective treatment for DME,” said Dr. Nehemy, professor of ophthalmology, Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil. “DME has a complex and multifactorial pathophysiology that could explain differences in response.”

    Dr. Nehemy outlined that previous studies have investigated the role of VMA in the response to anti-VEGF treatment for retinal vasculopathies. These studies have been conducted in eyes with age-related macular degeneration.1-4

    “On the other hand, a recent study including patients from READ-3 suggested that eyes with VMA could have a better visual outcome than eyes without VMA.5” Dr. Nehemy added. “Our current study was undertaken to further evaluate whether VMA was a biomarker for anti-VEGF outcomes in eyes with DME.”

     

    Study outlined

    The study included 195 eyes treated since 2012. Eyes with conditions that could affect the vitreomacular interface or visual acuity were excluded.

    The ophthalmic examination in all patients included slit-lamp evaluation, fluorescein angiography, and spectral-domain optical coherence tomography (OCT). Evaluation of the vitreomacular interface was done at the slit lamp and with OCT imaging of the macula and optic disc.

    Figure 1. A and B are SD-OCT of two eyes with DME that did not show vitreomacular adhesion. C and D are HD-OCT of the eyes shown in A and B respectively disclosed vitreoschisis with a cortical vitreous attached to the macula. (Images courtesy of Marcio Nehemy, MD)Images from some cases demonstrate the potential for misclassifying eyes as VMA-negative when using macula OCT alone (Figure 1).

    “OCT of the macula is not enough to evaluate the vitreomacular interface,” Dr. Nehemy said. “Relying on that technique by itself could explain the different results reported in various studies investigating the association between VMA and response to anti-VEGF therapy.”

    At baseline, eyes with VMA had a thicker central retina than eyes without VMA. Other comparisons at baseline showed a higher VMA prevalence in younger versus older patients (mean age of VMA-positive and VMA-negative eyes 58.2 and 62.3 years, respectively) and in men compared with women (55.5 % versus 31.6 %).

    Looking at BCVA

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