title: Vitreomacular Interface after Anti-Vascular Endothelial Growth Factor Injections in Neovascular Age-Related Macular Degeneration.
abstract: OBJECTIVE
  To evaluate the incidence of posterior vitreous detachment (PVD) induced by intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents in cases of neovascular age-related macular degeneration (AMD).
  
  
  METHODS
  Cohort study conducted at a single tertiary referral vitreoretinal practice.
  
  
  METHODS
  A total of 396 eyes of 295 patients were diagnosed with neovascular AMD between 2009 and 2014. A total of 125 eyes of 112 patients met the inclusion criteria and were evaluated in this study.
  
  
  METHODS
  This study included patients with neovascular AMD who presented vitreomacular adhesion (VMA) detected by spectral-domain optical coherence tomography (OCT) at baseline. Eyes with VMA were classified according to the diameter of vitreous attachment to the macular surface measured by OCT, with attachment of ≤1500 μm defined as focal and attachment of >1500 μm defined as broad. All patients received at least 3 monthly intravitreal injections of anti-VEGF agents. Follow-up visits were performed 1 month after each intravitreal injection and included OCT analysis to evaluate the incidence of PVD.
  
  
  METHODS
  Posterior vitreous detachment induced by anti-VEGF injections.
  
  
  RESULTS
  The mean follow-up period was 21.3 months (range, 3-59 months). The mean number of intravitreal injections was 8.3 (range, 3-29 injections). Intravitreal drugs used in the study were ranibizumab (51.5%), bevacizumab (33.5%), and aflibercept (15.0%). Seven eyes (5.6%) developed PVD after intravitreal drug injection (3 eyes after the first intravitreal injection: bevacizumab in 1 and ranibizumab in 2; 2 eyes after the second injection: ranibizumab in 1 and bevacizumab in 1; 1 eye after the fourth injection: ranibizumab; and 1 eye after the sixth injection: aflibercept). A total of 118 eyes remained with persistent VMA. All 7 eyes that developed PVD were classified as having focal VMA, with the diameter of vitreous attachment ranging from 210 to 1146 μm (mean, 600 μm).
  
  
  CONCLUSIONS
  Intravitreal injections of commonly used anti-VEGF intravitreal drugs rarely induce PVD in patients with neovascular AMD. Eyes with focal VMA have a greater chance to develop PVD than eyes with a broad area of VMA.
authors.affiliation: Retina Section, Department of Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. Electronic address: cerveloso@hotmail.com.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Veloso
authors.affiliation: Retina Section, Department of Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Tereza M
authors.initials: TM
authors.lastname: Kanadani
authors.affiliation: Retina Section, Department of Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Frederico B
authors.initials: FB
authors.lastname: Pereira
authors.affiliation: Retina Section, Department of Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Márcio B
authors.initials: MB
authors.lastname: Nehemy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000068258:Bevacizumab; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections; D008266:Macula Lutea / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000069579:Ranibizumab; D040262:Receptors, Vascular Endothelial Growth Factor / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D000267:Tissue Adhesions; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014822:Vitreous Body / Q000473:pathology*; D020255:Vitreous Detachment / Q000175:diagnosis / Q000209:etiology*; D057135:Wet Macular Degeneration / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D011993:Recombinant Fusion Proteins; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab