Vitreomacular Interface in Typical Exudative Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy

Purpose: To investigate the association in Japanese between posterior vitreous attachment and the pathologies of typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV), 2 major forms of exudative AMD. Design: Retrospective observational case series. Participants: A total of 378 eyes from 302 subjects (132 with typical AMD, 126 with PCV, 120 controls) from the University of Tokyo Hospital. Methods: Posterior vitreous detachment (PVD) and vitreomacular adhesion (VMA) were investigated by B-mode ultrasonography and spectral-domain optical coherence tomography (SD-OCT), respectively. The greatest linear dimension (GLD) of initial photodynamic therapy (PDT) in a subset of the patients (n = 92) receiving PDT was also investigated. Main Outcome Measures: Number of eyes with complete PVD and with VMA. The GLD of initial PDT. Results: In typical AMD eyes, the frequency of complete PVD was significantly lower (63 [56.8%] of 111 eyes) than in the controls (52 [70.3%] of 74 eyes, risk ratio [RR] 0.76, P = 0.021) and the frequency of VMA tended to be higher (14/115 [12.2%] in typical AMD eyes and 6/86 [7.0%] in the controls, RR 2.15, P = 0.099). The frequency of complete PVD [77 [63.1%] of the 122 eyes] and VMA (9/108 [8.3%]) in PCV eyes was the same as the controls (RR 0.91, P = 0.415 and RR 1.29, P = 0.615). In patients with unilateral exudative AMD, the frequency of complete PVD was lower in typical AMD eyes than in fellow eyes (odds ratio [OR] 0.111, P = 0.026) and VMA was observed in 7 (17.5%) and 3 (7.5%) typical AMD and fellow eyes, respectively (OR 2.33, P = 0.34), whereas in PCV eyes, the frequency of complete PVD was higher (OR 8.00, P = 0.045) and the frequency of VMA was the same as in the fellow eyes (OR 0.80, P = 1.00). The GLD of the eyes without complete PVD or with VMA was significantly larger than that in the eyes with complete PVD in typical AMD eyes (P = 0.042) and the same as that in the eyes with complete PVD in PCV eyes (P = 0.67). Conclusions: There is an association between posterior vitreous attachment and typical AMD. However, this association is not evident in PCV. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2011; 118: 853-859 (C) 2011 by the American Academy of Ophthalmology.