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Influence of vitreomacular interface on anti-vascular endothelial growth factor treatment outcomes in neovascular age-related macular degeneration: A MOOSE-compliant meta-analysis.

Abstract The aim of the study was to evaluate the influence of vitreomacular interface configuration on treatment outcomes after intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (AMD).The Pubmed, Embase, and Cochrane Central Register of Controlled Trials databases were searched to identify relevant prospective or retrospective studies that evaluate the influence of vitreomacular adhesion (VMA) or vitreomacular traction (VMT) on functional and anatomical outcomes in neovascular AMD patients treated with anti-VEGF agents. The outcome measures were the mean change in best corrected visual acuity (BCVA) from baseline, the mean change in central macular thickness (CMT) from baseline, and the mean injection numbers of anti-VEGF treatment from baseline.In total, 9 studies were selected for this meta-analysis, including 2156 eyes (404 eyes in the VMA/VMT group and 1752 eyes in the non-VMA/VMT group). In neovascular AMD patients treated with anti-VEGF agents, the VMA/VMT group was associated with poorer visual acuity gains and CMT reductions at 1 year (WMD [95% CI], -6.17 [-11.91, -0.43] early treatment diabetic retinopathy study (ETDRS) letters, P = .04; WMD [95% CI], 22.19 [2.01, 42.38] μm, P = .03, respectively). There was no significant difference between 2 groups in the mean BCVA change and the CMT change over 2 years (WMD [95% CI], -5.59 [-21.19, 10.01] ETDRS letters, P = .48; WMD [95% CI], 6.56 [-24.78, 37.90] μm, P = .68, respectively). There was no significant difference in the mean injection numbers between 2 groups at 1 year (WMD [95% CI], 0.36 [-0.19, 0.90], P = .21), whereas the VMA/VMT group had a significantly higher mean injection numbers over 2 years (WMD [95% CI], 1.14 [0.11, 2.16], P = .03).The limited evidence suggests that vitreomacular interface configuration have a significant influence on the visual acuity gain and CMT reduction at 1 year, injection numbers at 2 years in neovascular AMD patients treated with anti-VEGF agents. However, the results of this meta-analysis should be interpreted with caution because of the heterogeneity among study designs. Eyes with VMA/VMT on optical coherence tomography at baseline may require more intensive treatment with decreased response to anti-VEGF agents.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29390407
OWN - NLM
STAT- MEDLINE
DCOM- 20180212
LR  - 20180212
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 50
DP  - 2017 Dec
TI  - Influence of vitreomacular interface on anti-vascular endothelial growth factor
      treatment outcomes in neovascular age-related macular degeneration: A
      MOOSE-compliant meta-analysis.
PG  - e9345
LID - 10.1097/MD.0000000000009345 [doi]
AB  - The aim of the study was to evaluate the influence of vitreomacular interface
      configuration on treatment outcomes after intravitreal anti-vascular endothelial 
      growth factor (anti-VEGF) therapy for neovascular age-related macular
      degeneration (AMD).The Pubmed, Embase, and Cochrane Central Register of
      Controlled Trials databases were searched to identify relevant prospective or
      retrospective studies that evaluate the influence of vitreomacular adhesion (VMA)
      or vitreomacular traction (VMT) on functional and anatomical outcomes in
      neovascular AMD patients treated with anti-VEGF agents. The outcome measures were
      the mean change in best corrected visual acuity (BCVA) from baseline, the mean
      change in central macular thickness (CMT) from baseline, and the mean injection
      numbers of anti-VEGF treatment from baseline.In total, 9 studies were selected
      for this meta-analysis, including 2156 eyes (404 eyes in the VMA/VMT group and
      1752 eyes in the non-VMA/VMT group). In neovascular AMD patients treated with
      anti-VEGF agents, the VMA/VMT group was associated with poorer visual acuity
      gains and CMT reductions at 1 year (WMD [95% CI], -6.17 [-11.91, -0.43] early
      treatment diabetic retinopathy study (ETDRS) letters, P = .04; WMD [95% CI],
      22.19 [2.01, 42.38] mum, P = .03, respectively). There was no significant
      difference between 2 groups in the mean BCVA change and the CMT change over 2
      years (WMD [95% CI], -5.59 [-21.19, 10.01] ETDRS letters, P = .48; WMD [95% CI], 
      6.56 [-24.78, 37.90] mum, P = .68, respectively). There was no significant
      difference in the mean injection numbers between 2 groups at 1 year (WMD [95%
      CI], 0.36 [-0.19, 0.90], P = .21), whereas the VMA/VMT group had a significantly 
      higher mean injection numbers over 2 years (WMD [95% CI], 1.14 [0.11, 2.16], P = 
      .03).The limited evidence suggests that vitreomacular interface configuration
      have a significant influence on the visual acuity gain and CMT reduction at 1
      year, injection numbers at 2 years in neovascular AMD patients treated with
      anti-VEGF agents. However, the results of this meta-analysis should be
      interpreted with caution because of the heterogeneity among study designs. Eyes
      with VMA/VMT on optical coherence tomography at baseline may require more
      intensive treatment with decreased response to anti-VEGF agents.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Gao, Meng
AU  - Gao M
AD  - Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University.
FAU - Liu, LiMei
AU  - Liu L
AD  - Department of Ophthalmology, Yantai Yuhuangding Hospital, Affiliated Hospital of 
      Medical College, Qingdao University, Yantai, Shandong.
FAU - Liang, XiDa
AU  - Liang X
AD  - Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University.
FAU - Yu, YanPing
AU  - Yu Y
AD  - Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University.
FAU - Liu, XinXin
AU  - Liu X
AD  - Department of Ophthalmology, Kailuan General Hospital, Tangshan, China.
FAU - Liu, Wu
AU  - Liu W
AD  - Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Vascular Endothelial Growth Factor A)
SB  - AIM
SB  - IM
MH  - Age Factors
MH  - Blood-Retinal Barrier
MH  - Humans
MH  - Intravitreal Injections
MH  - Macula Lutea/*pathology
MH  - Vascular Endothelial Growth Factor A/*antagonists & inhibitors
MH  - Visual Acuity
MH  - Vitreous Body/*pathology
MH  - Wet Macular Degeneration/*drug therapy
EDAT- 2018/02/03 06:00
MHDA- 2018/02/13 06:00
CRDT- 2018/02/03 06:00
PHST- 2018/02/03 06:00 [entrez]
PHST- 2018/02/03 06:00 [pubmed]
PHST- 2018/02/13 06:00 [medline]
AID - 10.1097/MD.0000000000009345 [doi]
AID - 00005792-201712150-00157 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(50):e9345. doi: 10.1097/MD.0000000000009345.