title: EPIRETINAL MEMBRANES IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Effect on Outcomes of Anti-vascular Endothelial Growth Factor Therapy.
abstract: OBJECTIVE
  To iatients with neovascular age-related macular degenernvestigate the role of epiretinal membrane (ERM) on outcomes of anti-vascular endothelial growth factor therapy in pation (nAMD).
  
  
  METHODS
  This study is a retrospective observational case series and was conducted at the Gazi University School of Medicine, Ankara, Turkey. The reports of the patients with a diagnosis of new-onset nAMD, who were aged at least 50 years and treated with intravitreal anti-vascular endothelial growth factors (ranibizumab or bevacuzimab) between October 2010 and September 2013 in our retina clinic, were reviewed for the vitreomacular interface changes.
  
  
  RESULTS
  The study included 90 eyes of 90 patients with nAMD. The mean age of the patients was 70 ± 7.5 years, with 35 (38.9%) being male and 55 (61.1%) being female. According to the examinations with optical coherence tomography and B-mode ultrasonography, 43 patients had "concurrent" vitreomacular adhesion (30 focal, 13 broad; Group 1). Twenty-nine patients had complete posterior vitreous detachment (Group 2) and 18 patients (Group 3) had ERM. The number of injections was highest for the patients with ERM (Group 3), and this difference was statistically significant (P < 0.001). The mean interval between injections and the mean longest interval were shorter in Group 3 (P < 0.05).
  
  
  CONCLUSIONS
  The presence of ERM in association with nAMD seems to increase the number of anti-vascular endothelial growth factor injections and decrease the injection intervals for the treatment of nAMD. Although the anatomical and functional results are similar in eyes with or without ERM, the increased need for anti-vascular endothelial growth factors may mean that these membranes may decrease the penetration of the drugs through these membranes, which may act as a physical barrier. Additionally, increased inflammation in patients with ERM probably requires more frequent injections.
authors.affiliation: *Department of Ophthalmology, Sorgun State Hospital, Yozgat, Turkey; †Department of Ophthalmology, Yozgat State Hospital, Yozgat, Turkey; and ‡Department of Ophthalmology, Gazi University Medical Faculty, Ankara, Turkey.
authors.forename: Emine Esra
authors.initials: EE
authors.lastname: Karaca
authors.forename: Burçin
authors.initials: B
authors.lastname: Kepez Yldz
authors.forename: Mehmet Özgür
authors.initials: MÖ
authors.lastname: Çubuk
authors.forename: Şengül
authors.initials: Ş
authors.lastname: Özdek
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000627:therapeutic use; D019773:Epiretinal Membrane / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D000069579:Ranibizumab / Q000627:therapeutic use; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab