The Impact of the Vitreomacular Interface in Neovascular Age-Related Macular Degeneration in a Treat-and-Extend Regimen with Exit Strategy

Abstract

To evaluate the impact of the vitreomacular interface (VMI) in a treat-and-extend (TREX) regimen with exit strategy in patients with neovascular age-related macular degeneration (nAMD). Retrospective cohort study. Five hundred ninety-three eyes of 498 patients with nAMD. Eyes were treated according to a TREX regimen with an exit criterion, which was defined as no signs of disease activity during 3 consecutive 16-week injection visits. The impact of the VMI and the presence of an epiretinal membrane (ERM) assessed by spectral-domain OCT were evaluated based on the parameters mentioned below. Effect of vitreomacular adhesion (VMA) and ERM on mean treatment interval, number of injections, likelihood of fulfilling the exit criterion, choroidal neovascularization recurrences, CRT decrease, and BCVA improvement. During the TREX period, posterior vitreous detachment (PVD) eyes needed significantly fewer injections (mean, 10.6 ± 5.9) than VMA eyes (mean, 12.6 ± 6.7; P= 0.0008), and the mean injection interval was shorter in VMA eyes (8.3 ± 3.1 weeks) than in PVD eyes (9.5 ± 3.5 weeks; P= 0.0008). Eyes with PVD at baseline and without an ERM were 9.2 and 11.4 times more likely to fulfill the exit criterion than eyes with VMA and ERM, respectively (P= 0.006 and P= 0.004, respectively, corrected). Although CRT decrease (P= 0.16) and BCVA improvement (P= 0.32) did not differ with respect to the VMI configuration, ERM had a significant impact on CRT decrease (ERM present,+11 ± 198 μm vs. ERM absent,-92 ± 136 μm; P= 0.041). Vitreomacular adhesion at treatment cessation was associated significantly with disease recurrence (likelihood ratio, 7.8; P= 0.013, corrected), whereas the presence of an ERM was not associated with choroidal neovascularization recurrence (P= 0.18). The configuration of the VMI and the presence of an ERM have a significant impact on the treatment frequency, the chance to meet the exit criterion in this TREX regimen, and the recurrence risk aftertreatment cessation. This indicates that eyes with VMA should be monitored carefully for new disease activity after treatment cessation.