Auswirkung der Vitrektomie beim primär Makulagesunden auf die Entwicklung einer Altersbezogenen Makuladegeneration (AMD)

Purpose: This study analyses the consequences of vitreoretinal traction on the macula, and in particular the impact of a vitrectomy on the development of the age-related macular degeneration (AMD). Design: Retrospective case study Methods: In total, 42 eyes of 21 subjects were examined. The vitreous body of one eye must have been removed by vitrectomy at least 8 years ago. At that point in time the patients had to be at least 50 years old, with a healthy vitreous body of the other eye, and a healthy macula in both eyes. In the follow-up examination the patients had an average age of 73.6 years. First, the eyes where the vitreous body was still present were examined with regard to AMD using an optical coherence tomography (OCT) scan, B-scan ultrasonography, and a binokular slit-lamp. Second, both eyes were examined with fluorescence angiography (FAG) in order to better evaluate the potential development stage of an AMD. Results: In 0 of 21 eyes (0%) without a vitreous body, there were signs for an early AMD. In 5 of 21 eyes (23,8%) with a vitreous body, we found changes caused by AMD in the FAG and slit-lamp examinations. In these 21 Eyes, there were 5 eyes with persistent attachment of the posterior vitreous cortex to the macula, and 16 eyes with complete posterior vitreous detachment. In 5 of 5 eyes (100%) with signs of an early AMD the OCT and B-scan ultrasonography both showed persistent attachment of the posterior vitreous cortex to the macula. Conclusion: We have shown a positive relationship between a persistent attachment of the posterior vitreous cortex to the macula and an early AMD. Yet, the precise mechanism of this relationship remains unclear. The role of chronic low-grade inflammation, chronic oxidative and mechanical stress via vitreoretinal traction and the resulting production of vascular endothelial growth factors (VEGF) are dicussed. Persistent attachments can definitely not be seen as the only reason for the development of an AMD, but they are likely to be another risk factor. Further studies are needed to evaluate the benefit of a vitrectomy with regard to the development of an AMD, and to study the precise mechanism of the development of an AMD in eyes with persistent attachments of the posterior vitreous cortex to the macula.