Sebastian M Waldstein1, Markus Ritter1, Christian Simader2, Ulrike Mayr-Sponer1, Michael Kundi3, Ursula Schmidt-Erfurth1. 1. Christian-Doppler-Laboratory for Ophthalmic Image Analysis, Vienna Reading Center, Department of Ophthalmology, Vienna, Austria. 2. Christian-Doppler-Laboratory for Ophthalmic Image Analysis, Vienna Reading Center, Department of Ophthalmology, Vienna, Austria. Electronic address: optima@meduniwien.ac.at. 3. Institute of Environmental Health, Center for Public Health, Medical University of Vienna, Vienna, Austria.
Abstract
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. 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.
RCT Entities:
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. 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.
Authors: Thomas A Ciulla; Thomas A Cuilla; Gui-Shuang Ying; Maureen G Maguire; Daniel F Martin; Glenn J Jaffe; Juan E Grunwald; Ebenezer Daniel; Cynthia A Toth Journal: Ophthalmology Date: 2015-03-29 Impact factor: 12.079
Authors: Miltiadis K Tsilimbaris; Maria I López-Gálvez; Roberto Gallego-Pinazo; Philippe Margaron; George N Lambrou Journal: J Ophthalmol Date: 2016-03-17 Impact factor: 1.909