Korean J Ophthalmol.  2015 Dec;29(6):396-403. 10.3341/kjo.2015.29.6.396.

Effects of Vitreomacular Traction on Ranibizumab Treatment Response in Eyes with Neovascular Age-related Macular Degeneration

• Lee KH
• Chin HS
• Kim NR
• Moon YS

• KMID: 2363847
• DOI: http://doi.org/10.3341/kjo.2015.29.6.396

Abstract

PURPOSE
To investigate the effects of vitreomacular traction (VMT) on ranibizumab treatment response for neovascular age-related macular degeneration (AMD).
METHODS
A retrospective review of 85 eyes of 85 patients newly diagnosed with neovascular AMD was conducted. Patients were eligible if they had received more than three consecutive monthly ranibizumab (0.50 mg) treatments and ophthalmic evaluations. Patients were classified into a VMT (+) group or VMT (-) group according to optical coherence tomography imaging. Best corrected visual acuity and central retinal thickness (CRT) measurements were obtained at three and six months after initial injection.
RESULTS
One month after the third injection, mean visual acuity (VA) increases of 6.36 and 9.87 letters were observed in the VMT (+) and VMT (-) groups, respectively. The corresponding mean CRT values decreased by 70.29 microm and 121.68 microm, respectively. A total 41 eyes were identified as eligible for a subsequent fourth injection; 71.1% of patients (27 eyes) in the VMT (+) group but only 29.8% of patients in the VMT (-) group needed a subsequent fourth injection. Follow-up was extended to six months for 42 of the 85 enrolled patients (49.4%). The trends in VA and optical coherence tomography were found to be maintained at six-month follow-up.
CONCLUSIONS
VA and CRT appeared to be more improved after ranibizumab treatment in the VMT (-) group compared to the VMT (+) group. VMT might antagonize the effect of ranibizumab treatment in a subpopulation of AMD patients.

Keyword

Anti-vascular endothelial growth factor; Neovascular age-related macular degeneration; Optical coherence tomography; Ranibizumab; Vitreomacular traction

MeSH Terms

Aged
Aged, 80 and over
Angiogenesis Inhibitors/*therapeutic use
Female
Follow-Up Studies
Humans
Intravitreal Injections
Male
Middle Aged
Ranibizumab/*therapeutic use
Retina/pathology
Retinal Diseases/*physiopathology
Retrospective Studies
Tissue Adhesions
Tomography, Optical Coherence
Vascular Endothelial Growth Factor A/antagonists & inhibitors
Visual Acuity/drug effects
Vitreous Body/*pathology
Wet Macular Degeneration/*drug therapy/physiopathology
Angiogenesis Inhibitors
Ranibizumab
Vascular Endothelial Growth Factor A

Figure

• 

  Fig. 1 Visual acuities of eyes with neovascular age-related macular degeneration treated with three consecutive monthly loadings of ranibizumab. Red and blue lines indicate mean values in the vitreomacular traction (-) and vitreomacular traction (+) groups, respectively. Statistical significance of differences throughout the three-month period was confirmed by p-values of 0.036, 0.016, 0.014, respectively, according to independent t-test.

• 

  Fig. 2 Central retinal thicknesses of eyes with neovascular age-related macular degeneration treated with ranibizumab over three months. Red and blue lines indicate mean values in the vitreomacular traction (-) and vitreomacular traction (+) groups, respectively. Statistical significance of differences throughout the three-month period was confirmed by p-values of 0.023, 0.018, and 0.007, respectively, according to independent t-test.

• 

  Fig. 3 The anterior-posterior traction forces of vitreomacular traction (VMT) lead to stretching of retinal pigment epithelium (RPE) cells and stimulate Müller cells to release vascular endothelial growth factor (VEGF). VEGF then induces chronic lowgrade inflammation, which directly aggravates VMT. This VMT then completes a vicious cycle by causing local ischemia and consequently increasing VEGF level. BRB = blood-retinal barrier.

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