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

      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.
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      Biography

      Sebastian M. Waldstein is a supervisor at the Vienna Reading Center (VRC) and a resident at the Department of Ophthalmology, Medical University Vienna, Austria. He coordinates the Christian-Doppler-Laboratory for Ophthalmic Image Analysis, a multidisciplinary research endeavor aiming at the personalization of antiangiogenic treatment strategies for macular diseases by automated analysis and interpretation of large-scale optical coherence tomography data. His primary research interests are neovascular age-related macular degeneration and innovative retinal imaging.