The Role of Abnormal Vitreomacular Adhesion in Age-related Macular Degeneration: Spectral Optical Coherence Tomography and Surgical Results

Mojana, Francesca; Cheng, Lingyun; Bartsch, Dirk-Uwe G.; Silva, Gabriel A.; Kozak, Igor; Nigam, Nitin; Freeman, William R.

doi:10.1016/j.ajo.2008.04.027

« Previous Next »American Journal of Ophthalmology
Volume 146, Issue 2 , Pages 218-227.e1, August 2008

The Role of Abnormal Vitreomacular Adhesion in Age-related Macular Degeneration: Spectral Optical Coherence Tomography and Surgical Results

Francesca Mojana
- Jacobs Retina Center at the Shiley Eye Center, Department of Ophthalmology, University of California San Diego, La Jolla, California
Lingyun Cheng
- Jacobs Retina Center at the Shiley Eye Center, Department of Ophthalmology, University of California San Diego, La Jolla, California
Dirk-Uwe G. Bartsch
- Jacobs Retina Center at the Shiley Eye Center, Department of Ophthalmology, University of California San Diego, La Jolla, California
Gabriel A. Silva
- Jacobs Retina Center at the Shiley Eye Center, Department of Ophthalmology, University of California San Diego, La Jolla, California
- Department of Bioengineering, University of California San Diego, La Jolla, California.
Igor Kozak
- Jacobs Retina Center at the Shiley Eye Center, Department of Ophthalmology, University of California San Diego, La Jolla, California
Nitin Nigam
- Jacobs Retina Center at the Shiley Eye Center, Department of Ophthalmology, University of California San Diego, La Jolla, California
William R. Freeman
- Jacobs Retina Center at the Shiley Eye Center, Department of Ophthalmology, University of California San Diego, La Jolla, California
- Inquiries to William R. Freeman, University of California San Diego Department of Ophthalmology, Shiley Eye Center, 0946, Joan and Irwin Jacobs Retina Center, 9415 Campus Point Drive, La Jolla, CA 92037

Accepted 15 April 2008. published online 22 May 2008.

Purpose

To assess the incidence of vitreomacular adhesion and traction in age-related macular degeneration (AMD), and to evaluate surgical treatment in a subset of patients with choroidal neovascularization (CNV) nonresponsive to anti-neovascular growth factor (anti-VEGF) treatment.

Design

Retrospective observational case-control and interventional case series.

Methods

Spectral optical coherence tomography, combined with simultaneous scanning laser ophthalmoscope (Spectral OCT/SLO), was performed in 170 eyes of 94 elderly patients, 61 with exudative AMD, 59 with nonexudative AMD, and 50 control eyes. The presence of hyaloid adhesion to the posterior pole, and vitreomacular traction (VMT) were determined. Five patients with VMT underwent surgical hyaloid removal. Best-corrected visual acuity (BCVA) and retinal thickness were evaluated as outcomes.

Results

Hyaloid adhesion was present in 17 eyes with exudative AMD (27.8%), 15 eyes with nonexudative AMD (25.4%), and eight control eyes (16%). Significant difference was found among the groups (P = .002). Among the eyes with hyaloid adhesion, VMT was shown in 10 eyes (59%) with exudative AMD, two eyes (13%) with nonexudative AMD, and one control eye (12%). VMT was associated with the severity of AMD (P = .0082). The area of hyaloid adhesion was significantly smaller than and concentric to the area of CNV complex in eyes with exudative AMD. Eyes with VMT that underwent surgery experienced a modest improvement of BCVA and decrease of retinal thickness.

Conclusions

Hyaloid adhesion to the macula is associated with AMD, and frequently causes VMT in eyes with CNV. Tractional forces may antagonize the effect of anti-VEGF treatment, and cause pharmacological resistance in a subpopulation of patients. Future studies are needed to define the role of vitreoretinal surgery in such cases. Spectral OCT/SLO allows careful diagnosis and follow-up.