Case Blog - Journal of Clinical Ophthalmology (2019) Volume 3, Issue 2
Vitreomacular adhesion a risk factor and inducing PVD a treatment option in patients with age related macular degeneration.
Purpose: To compare the state of posterior vitreous in the aetiology of exudative age related macular degeneration (wet AMD) with non-exudative age related macular degeneration (dry AMD) and controls.
Method: We did a Prospective comparative study of 200 eyes of patients aged more than 65 years with Spectral domain OCT and ultrasonography over a period of one year. All subjects underwent a detailed history, physical examination and comprehensive ocular examination. Other ocular conditions like diabetic retinopathy, macular pucker, macular hole, inflammatory diseases, myopia of more than 2D and previous ocular surgeries are excluded from the study. Eyes with evidence of neo vascular AMD confirmed by FFA and ICG were included in group 1. Eyes with pigmentary changes at macula or drusens were included in group 2 and eyes without any changes are included in group 3. These patients were followed up for duration of 6 months to see the progression at vitreomacular interface.
Results: In the present study, there is a significantly higher prevalence of VMA in patients with choroidal neovascularisation in comparison to eyes with dry AMD and controls. More specifically the attachment site of vitreous to the macula corresponds to the location of choroidal neovascularisation further suggesting the relationship (95%). Patients treated with vitrectomy and anti VEGF for associated VMT showed favourable results in terms of recurrence, visual acuity and number of anti VEGF injections. Also patients with VMA and CNVM needed more frequent injections in comparison to patients with no VMA.
Conclusion: Persistent attachment of the posterior vitreous cortex to the macula is another risk factor for the development and progression of exudative AMD. Inducing PVD could be a treatment option.Author(s): Krishna Nagaradh, Prarthana Gokarn