Vitreomacular interface after anti-VEGF injections in diabetic macular edema

Abstract

Background The purpose of this study was to evaluate the incidence of vitreomacular adhesion (VMA) release after anti-VEGF therapy for the treatment of diabetic macular edema (DME) and to evaluate further changes in outcome. Methods This was a retrospective study that enrolled 66 eyes of 66 patients with DME who presented with VMA diagnosed by spectral-domain optical coherence tomography (OCT) at baseline. VMA was classified as focal (attachment: ≤ 1500\xa0μm) or broad (attachment: > 1500\xa0μm). All patients received at least three monthly intravitreal injections of an anti-VEGF agent. Follow-up visits were performed 1 month after each injection to evaluate the incidence of VMA release. Results The mean patient age was 61.4 years (range: 29 to 78 years), and 72.7\u2009% were male. The mean best-corrected visual acuity was 0.62 logMAR, and the mean central retinal thickness (CRT) was 473\xa0μm at baseline. The mean length of follow-up was 18.5 months, and the mean number of injections was 5.8. The intravitreal drugs used were aflibercept (40.9\u2009%), ranibizumab (37.9\u2009%) and bevacizumab (21.2\u2009%). Forty-seven eyes had broad VMA, and 19 had focal VMA. Twenty-two eyes (33.3\u2009%) developed VMA release following a mean of 5.7 injections (range: 3–13). Sixteen eyes (72.7\u2009%) with focal VMA and 6 eyes (27.3\u2009%) with broad VMA at baseline developed VMA release. Twenty-one eyes that developed VMA release showed an improvement in CRT following VMA release (mean: -106\xa0μm; range: 22 to 289\xa0μm). Conclusions VMA release occurs in approximately 1/3 of patients with DME following anti-VEGF therapy. Most of them show a short-term decrease in CRT.