The Role of Epiretinal Membrane on Treatment of Neovascular Age‐Related Macular Degeneration with Intravitreal Bevacizumab

Abstract

Purpose. To determine the effect of epiretinal membranes (ERM) on the treatment response and the number of intravitreal bevacizumab injections (IVB) in patients with neovascular age-related macular degeneration (nAMD). Methods. A retrospective chart review was performed on 63 eyes of 63 patients. The patients were divided into AMD group (n = 35) and AMD/ERM group (n = 28). Best corrected visual acuity (BCVA) and central retinal thickness (CRT), as well as the number of injections, were evaluated. Results. There was a significant improvement in BCVA at 3 months for the AMD and AMD/ERM groups (P = 0.02, P = 0.03, resp.). At 6, 12, and 18 months, BCVA did not change significantly in either of the groups compared to baseline (P > 0.05 for all). At 3, 6, 12, and 24 months, the AMD group had an improvement in BCVA (logMAR) of 0.09, 0.06, 0.06, and 0.03 versus 0.08, 0.07, 0.05, and 0.03 for the AMD/ERM group (P = 0.29, P = 0.88, P = 0.74, P = 0.85, resp.). A significant decrease in CRT occurred in both groups for all time points (P < 0.001 for all). The change in CRT was not statistically different between the two groups at all time points (P > 0.05 for all). The mean number of injections over 24 months was 8.8 in the AMD group and 9.2 in the AMD/ERM group (P = 0.76). Conclusion. During 24 months, visual and anatomical outcomes of IVB in nAMD patients were comparable with those in nAMD patients with ERM with similar injection numbers.

Short term effect of intravitreal bevacizumab for diabetic macular edema associated with epiretinal membrane

“…Several studies have reported the effect of ERM on response to anti-VEGF agents in retinochoroidal diseases other than diabetic retinopathy [ 15 - 19 ]. In a retrospective chart review of 63 eyes of 63 patients, Alkin et al did not find any significant differences in terms of BCVA improvement, central retinal thickness (CRT) change and mean number of bevacizumab injections in eyes with naive treatment newly diagnosed neovascular AMD alone, and those associated with ERM in an over 24-months follow-up [ 15 ]. Chatziralli et al stated that in a one-year follow-up, patients with wet AMD and ERM needed more injections than patients with wet AMD alone.…”

Epidemiological and Clinical Baseline Characteristics as Predictive Biomarkers of Response to Anti-VEGF Treatment in Patients with Neovascular AMD

“…Retrospective review of medical records from patients with nAMD found that VMA at baseline was associated with poor treatment outcomes in response to ranibizumab at month 12 [ 55 ] and in response to ranibizumab or bevacizumab after nearly 2 years ( p = 0.02) [ 61 ]. Lastly, the effect of an idiopathic epiretinal membrane on both visual and anatomical outcome in response to bevacizumab has been evaluated by a retrospective medical records review and found to have no significant effect at 2 years [ 40 ].…”

Effect of Epiretinal Membrane Peeling on Intravitreal Aflibercept Therapy Response for Polypoidal Choroidal Vasculopathy: A Case Report

“…Traction forces may lead to a breakdown in the architecture of the RPE, Bruch's membrane, and photore- ceptor layer, which may result in a reduction in the effectiveness of anti-VEGF agents (4). In addition, the presence of a membrane may act as a physical barrier and result in reduced penetration of the anti-VEGF agents through these membranes, leading to pharmacological resistance to anti-VEGF treatment (3,4). In our case, we continued treatment with intravitreal aflibercept injections after the surgery and observed an improvement in anatomical results, although the BCVA remained the same as before the surgery.…”

“…Idiopathic epiretinal membrane (ERM) is another cause of visual acuity deterioration due to traction forces on the retinal surface in the same group of older patients. The coexistence of the aforementioned conditions may cause difficulties in the management of PCV with anti-VEGF therapy (3).…”