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Vitreomacular interface after anti-VEGF injections in diabetic macular edema
Carlos E Veloso1, Daniel N Brocchi2, Rishi P Singh3
1Department of Ophthalmology, Federal University of Minas Gerais, Avenida Nossa Senhora do Carmo 90, Savassi, Belo Horizonte, MG, 30330-000, Brazil. cerveloso@hotmail.com.
Background:
The purpose of this study was to evaluate the incidence of vitreomacular adhesion (VMA) release after anti-VEGF therapy for the treatment of diabetic macular edema (DME) and to evaluate further changes in outcome.
Methods:
This was a retrospective study that enrolled 66 eyes of 66 patients with DME who presented with VMA diagnosed by spectral-domain optical coherence tomography (OCT) at baseline. VMA was classified as focal (attachment: ≤ 1500 μm) or broad (attachment: > 1500 μm). All patients received at least three monthly intravitreal injections of an anti-VEGF agent. Follow-up visits were performed 1 month after each injection to evaluate the incidence of VMA release.
Results:
The mean patient age was 61.4 years (range: 29 to 78 years), and 72.7 % were male. The mean best-corrected visual acuity was 0.62 logMAR, and the mean central retinal thickness (CRT) was 473 μm at baseline. The mean length of follow-up was 18.5 months, and the mean number of injections was 5.8. The intravitreal drugs used were aflibercept (40.9 %), ranibizumab (37.9 %) and bevacizumab (21.2 %). Forty-seven eyes had broad VMA, and 19 had focal VMA. Twenty-two eyes (33.3 %) developed VMA release following a mean of 5.7 injections (range: 3-13). Sixteen eyes (72.7 %) with focal VMA and 6 eyes (27.3 %) with broad VMA at baseline developed VMA release. Twenty-one eyes that developed VMA release showed an improvement in CRT following VMA release (mean: -106 μm; range: 22 to 289 μm).
Conclusions:
VMA release occurs in approximately 1/3 of patients with DME following anti-VEGF therapy. Most of them show a short-term decrease in CRT.
Insights
Vitreomacular adhesion (VMA) release occurred in about one-third of patients with diabetic macular edema (DME) treated with anti-VEGF therapy. This release was associated with a short-term reduction in central retinal thickness.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Pharmacology
Background:
- Diabetic macular edema (DME) is a leading cause of vision loss.
- Vitreomacular adhesion (VMA) can contribute to DME progression.
- Anti-VEGF therapy is a standard treatment for DME.
Purpose of the Study:
- To determine the incidence of VMA release after anti-VEGF therapy in patients with DME.
- To evaluate changes in outcomes following VMA release.
Main Methods:
- Retrospective study of 66 eyes with DME and baseline VMA.
- VMA classified as focal (≤ 1500 μm) or broad (> 1500 μm).
- Patients received at least three monthly anti-VEGF injections; VMA release assessed post-injection.
Main Results:
- 33.3% of eyes (22/66) experienced VMA release after a mean of 5.7 injections.
- VMA release was more common in focal VMA (72.7%) than broad VMA (27.3%).
- 21 eyes with VMA release showed a mean decrease in central retinal thickness of 106 μm.
Conclusions:
- VMA release is a notable event in approximately one-third of DME patients undergoing anti-VEGF treatment.
- VMA release is more frequent in cases of focal VMA.
- VMA release is associated with a short-term improvement in central retinal thickness.
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