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Vitreomacular Adhesion and the Risk of Neovascular Age

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Vitreomacular Adhesion and the Risk of Neovascular Age Correspondence Re: Maggio et al.: Vitreomacular studies have used. Indeed, in past studies ultrasound imaging was adhesion and the risk of neovascular critical for accurately diagnosing the presence or absence of PVD. age-related macular degeneration It is well-known that a PVD often displaces the posterior vitreous cortex so far anteriorly that it cannot be imaged with (Ophthalmology. 2017;124:657-666) conventional OCT (Fig 1). In older individuals with AMD, the vitreous is highly liquefied and more prone to farther anterior TO THE EDITOR: We have read with interest the recent publication of displacement of the posterior vitreous than in younger Maggio et al, wherein they report no relationship between the state 5 of the vitreomacular interface and the risk of neovascular age- individuals. In the absence of perifoveal PVD, spectral- related macular degeneration (AMD). This finding is in contrast domain OCT alone is unable to distinguish between total with multiple previous studies, which found that the presence of a attachment of vitreous to the posterior pole and PVD with remote posterior vitreous detachment (PVD) was associated with dry anterior displacement. Thus, in this study many cases of PVD AMD, whereas vitreomacular adhesion is a risk factor for exudative could have been interpreted as total vitreous attachment, intro- e fl fi AMD.1 3 Studies have also found that vitreomacular adhesion ducing inaccuracy and in uencing the ndings and conclusions, hampers therapy with anti-vascular endothelial growth factor in- which are inconsistent with previous studies that used ultrasound jections, necessitating more injections with poorer results.4 One imaging, as well as OCT to accurately diagnose the state of the possible explanation for this incongruity is that this most recent vitreoretinal interface. Future studies with swept-source study only used optical coherence tomography (OCT) to evaluate OCT may well be able to distinguish between vitreous attach- fi the state of the vitreous, and not ultrasound imaging, as previous ment and total PVD, as long as imaging is suf ciently anterior to detect a displaced posterior vitreous cortex. 1 J. SEBAG,MD 2 SUSANNE BINDER,MD 1VMR Institute for Vitreous Macula Retina, Huntington Beach, California; 2Department of Ophthalmology, Sigmund Freud Privatuniversität, Wien, Österreich Financial Disclosures: The authors have no proprietary or commercial interest in any materials discussed in this article. Available online: ---. Correspondence: J. Sebag, MD, VMR Institute for Vitreous Macula Retina, 7677 Center Avenue, Suite 400 California, Huntington Beach, CA 92647. E-mail: [email protected]. References 1. Krebs I, Brannath W, Glittenberg K, et al. Posterior vitreo- macular adhesion: a potential risk factor for exudative age- related macular degeneration. Am J Ophthalmol. 2007;144: 741-746. 2. Robison C, Krebs I, Binder S, et al. Vitreo-macular adhesion in active and end-stage age-related macular degeneration. Am J Ophthalmol. 2009;148:79-82. 3. Krebs I, Glittenberg C, Binder S. Vitreous in age-related macular Figure 1. A, Ultrasound image from a 62-year-old man with posterior degeneration. In: Sebag J, ed. Vitreous e In Health and Disease. vitreous detachment (PVD). The typical sigmoid-shaped appearance of a New York: Springer; 2014:329-346. PVD is evident and the detached posterior vitreous cortex is clearly visible 4. Sebag J. Vitreous in AMD therapy e the medium is the message anterior to the retina. B, Spectral-domain optical coherence tomography (Guest Editorial). Retina. 2015;35(9):1715-1718. (OCT) of the same eye as panel A shows no evidence of PVD, despite 5. Tozer K, Johnson MW, Sebag J. Vitreous aging and posterior maximizing visualization of the posterior vitreous body by placing the vitreous detachment. In: Sebag J, ed. Vitreous - in Health & retinal image at the far bottom of the scan. Disease. New York: Springer; 2014:131-150. e1 COR 5.5.0 DTD OPHTHA9945_proof 6 November 2017 9:51 pm ce.
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