A Meta-analysis Of The Effect Of The Vitreous Macular Interface On The Efficacy Of Anti-VEGF Drugs In The Treatment Of NAMD

Objective:To determine whether vitreomacular adhesion(VMA)or vitreomacular traction(VMT)has an influence on the outcomes of anti-vascular endothelium growth factor(anti-VEGF)treatment neovascular age-related macular degeneration(nAMD).Methods:A systematic literature search was performed in Pubmed.gov,Cochrane Library,Web of Science,China National Knowledge Infrastructure,Wanfang,SinoMed,and ClinicalTrials.gov up to June 30,2016 to identify eligible studies.Results:Nine studies and 2212 participants were finally identified.At month 6,the mean improvement in best-corrected visual acuity(BCVA)and mean decline in central retinal thickness(CRT)of the VMA/MT(+)group was less than that of the VMA/VMT(-)group(95%confidence interval[CI],[-3.05,-0.96]letters,P =.0002;[15.53,32.98]?m,P<.00001;respectively);at month 12,there was a small or only marginally significant difference([-0.01,2.00]letters,P =.05;[0.17,23.71]?m,P=.05;respectively)between the groups.During the 12 months,however,the VMA/VMT(+)group required more injections([0.25,0.95],P =.0008).Conclusions:In using anti-VEGF drugs to treat nAMD,clinicians should take into account the fact that concurrent VMA or VMT might antagonize the efficacy of anti-VEGF drugs during the early stage of treatment.