The Role Of Abnormal Vitreomacular Interface On Poor Response To Anti-VEGF Treatment In WAMD Patient: A Meta Analysis

Objective: To evaluate whether abnormal vitreomacular interface(VMI)at baseline can lead to poor response to anti vascular endothelial growth factor(VEGF)treatment in patients with wet age-related macular degeneration(w AMD).Methods: Two reviewers conducted the searches independently.The Pub Med,Embase,and Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure were systematically searched without restrictions regarding publication year or language.The data were extracted independently by 2 reviewers.The information extracted from each study included the authors of each study,the year of,location of the trial,information on study design,number of subjects,the anti-VEGF treatment strategy,the mean change in best corrected visual acuity(BCVA),the mean change in central macular thickness.The extracted data was analyzed using Reman5.2 software based on strict quality evaluation.Result: Totally,11 studies were selected for this meta-analysis,including 2656 eyes(753 eyes in the abnormal VMI group and 1903 eyes in the normal VMI group).All the patients included received at least 3months treatment continuously.After the loading treat,the follow-up treatment options for patients include: pro re nata(PRN),treatment and extension(T&E),and monthly.And studies provide specific counting data for at least one follow-up at 3,6 or 12 months after the initial treatment.Meta analysis results show:(1)In w AMD patients treated with anti-VEGF agents,the abnormal VMI group was associated with poorer visual acuity gains at the t at 3,6months after the initiation of treatment(P=0.02,P=0.005).(2)At 12 month after the initiation of treatment,the abnormal VMI group was associated with poorer visual acuity gains in patients treated with PRN regimen VMI(P<0.05),but not in patients treated with T&E or monthly regimen(P=0.15).(3)There is no significant difference in CRT reductions between two groups at at 3,6,and 12 months after the initiation of treatment(P=0.49,P=0.83,P=0.87,respectively).Conclusion: Abnormal VMI may lead to poor response to anti-VEGF in patients with w AMD,but the effect is gradually weakened with the prolongation of treatment time and the increase of treatment frequency.