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• W2096351386 abstract "We read with interest the report of Simpson et al 5 Simpson A.R. Petrarca R. Jackson T.L. Vitreomacular adhesion and neovascular age-related macular degeneration. Surv Ophthalmol. 2012; 57: 498-509 Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar speculating upon the role of the vitreomacular interface (VMI) in the pathogenesis of age-related macular degeneration (AMD). The authors propose both vitrectomy and pharmacologic vitreolysis as therapeutic options in alteration of the VMI. There is, however, a third possibility that we believe holds equal appeal—direct and indirect effects of the intravitreal injection itself. Alterations of intraocular structure and function that may result from intravitreal injection are not yet fully elucidated. Although effects upon intraocular pressure 2 Benz M.S. Albini T.A. Holz E.R. et al. Short-term course of intraocular pressure after intravitreal injection of triamcinolone acetonicde. Ophthalmology. 2006; 113: 1174-1178 Abstract Full Text Full Text PDF PubMed Scopus (103) Google Scholar and anterior chamber depth 3 Kerimoglu H. Ozturk B.T. Bozkurt B. et al. Does lens status affect the course of early intraocular pressure and anterior chamber changes after intravitreal injection?. Acta Ophthalmol. 2011; 89: 138-142 Crossref PubMed Scopus (17) Google Scholar from such injections are well documented, one must intuit that there are considerable additional mechanical changes to the vitreous and posterior segment as collateral effects of such mechanical forces. Accelerated vitreous synchysis, an increase in posterior segment volume, shearing force distortions, and reduction in retinal thickness are a few potential actors in this dynamic. In animal models, changes to the ganglion cell layer which alter its response to photocoagulation occur, even when intravitreal injection is performed without any active compound. 1 Belokopytov M. Shulman S. Dubinsky G. et al. Intravitreal saline injection ameliorates laser-induced retinal damage in rats. Retina. 2012; 32: 1165-1170 Crossref PubMed Scopus (6) Google Scholar Additionally, there are reported cases of successful treatment of vitreomacular traction (VMT) with intravitreal corticosteroid; 4 Seymenoğlu G. Kayıkçıoğlu O. Sahin B.Ö. Resolution of vitreomacular traction following intravitreal triamcinolone acetonide injection in an eye with branch retinal vein occlusion. Clin Ophthalmol. 2012; 6: 1239-1243 PubMed Google Scholar given the presumed absence of inflammation in VMT, one must consider the possibility that the injection itself may be the actor in inducing such changes that are therapeutic, and the steroid but the passive audience. Although we commend Simpson et al for their insight, we await with anticipation further delineation of other more elusive and overlooked vitreal mechanical changes that may also serve to induce regression of AMD. Vitreomacular Adhesion and Neovascular Age-Related Macular DegenerationSurvey of OphthalmologyVol. 57Issue 6PreviewWe explore the hypothesis that vitreomacular adhesion (VMA) and vitreomacular traction (VMT) play a role in the pathogenesis and clinical course of neovascular (“wet”) age-related macular degeneration (AMD). Several biological theories are offered to explain this possible association, including direct tractional force, altered vitreous oxygenation, altered diffusion coefficients of intravitreal molecules, and alterations in the pharmacokinetics of intravitreal drugs. Release of VMT may improve the clinical course of neovascular AMD, and a few case series suggest that vitrectomy can lead to both a functional and anatomic improvement. Full-Text PDF Author's responseSurvey of OphthalmologyVol. 59Issue 2PreviewWe thank Katz et al for their insightful comments on the use of an intravitreal fluid injection as a potential therapy for the treatment of vitreomacular adhesion (VMA). We agree that the mechanical forces that occur when injecting saline (or equivalent) into the vitreous cavity may well alter the vitreous, although the magnitude of the effect is difficult to quantify. Stalmans et al, on behalf of the MIVI-TRUST Study Group, showed that a 0.10 mL injection of ocriplasmin resulted in a higher rate of VMA resolution at day 28 compared with a 0.10 mL saline placebo injection (26.5% vs 10.1%),6 confirming that ocriplasmin was producing a therapeutic effect, but the rate of VMA resolution in the placebo injection arm was similar to the 11% rate of spontaneous VMA resolution over a 5-year natural history study by Hikichi et al. Full-Text PDF" @default.
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• W2096351386 title "Vitreomacular adhesion and neovascular age-related macular degeneration" @default.
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