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VITREOUS ATTACHMENT IN AGE-RELATED MACULAR DEGENERATION, DIABETIC MACULAR EDEMA, AND RETINAL VEIN OCCLUSION: A Systematic Review and Metaanalysis

Jackson, Timothy L. PhD, FRCOPHTH*; Nicod, Elena MSc; Angelis, Aris MSc; Grimaccia, Federico MD; Prevost, A. Toby PhD; Simpson, Andrew R. H. MRCOphth*,§; Kanavos, Panos PhD

doi: 10.1097/IAE.0b013e31828991d6
Review

Purpose: To determine if there is an association of vitreous attachment and wet age-related macular degeneration (AMD), diabetic macular edema, and retinal vein occlusion.

Methods: Systematic review and metaanalysis.

Results: Sixteen of 1,025 articles were eligible. In wet AMD, the prevalence of vitreomacular adhesion and posterior vitreous detachment was 23% (654 eyes) and 41% (251), respectively. Vitreomacular adhesion prevalence was 2.15 times that of controls (95% confidence interval, 1.34–3.48; p = 0.002) and 2.54 times that of dry AMD (confidence interval, 0.88–7.36; p 0.09); posterior vitreous detachment prevalence was lower than controls (relative risk 0.77; confidence interval, 0.64–0.93; p = 0.007) and dry AMD (0.56; confidence interval, 0.27–1.14; p = 0.11). It was not possible to determine the prevalence of vitreous attachment in diabetic macular edema, but vitreomacular traction was present in 29% of 188 surgical cases. The prevalence of posterior vitreous detachment in eyes with central and branch retinal vein occlusion was 30% (56 eyes) and 31% (71 eyes), respectively, versus 25% (64 eyes) in controls.

Conclusion: Observational studies of sufficient quality indicate that eyes with wet AMD have double the expected prevalence of vitreomacular adhesion and are less likely to have a posterior vitreous detachment. More controlled studies of diabetic macular edema and retinal vein occlusion are needed.

Metaanalysis found that wet age-related macular degeneration is associated with vitreous attachment. There is insufficient evidence to establish if diabetic macular edema and retinal vein occlusion are associated with vitreous attachment.

*Guthrie Clinic, King's College Hospital, London, United Kingdom;

Department of Social Policy, LSE Health, London School of Economics and Political Science, London, United Kingdom;

Department of Primary Care and Public Health Sciences; and

§Department of Ophthalmology, King's College London, London, United Kingdom.

Reprint requests: Timothy L. Jackson, FRCOphth, PhD, Guthrie Clinic, King's College Hospital, London SE5 9RS, United Kingdom; e-mail: t.jackson1@nhs.net

This project was supported by an unrestricted educational grant from Thrombogenics.

A component of the article has been accepted for poster presentation at the Royal College of Ophthalmologists’ Meeting in the United Kingdom.

T. Jackson is a Consultant to Thrombogenics.

The authors declare no conflict of interest.

© 2013 by Ophthalmic Communications Society, Inc.