Reduced effect of anti-vascular endothelial growth factor agents on diabetics with vitreomacular interface abnormalities

This study investigated whether the presence of vitreomacular interface abnormalities (VMIAs) affects the improvement in visual acuity and edema of patients with diabetic macular edema (DME) who received three anti-vascular endothelial growth factor (VEGF) injections. Fifteen eyes of 11 patients with clinically significant macular edema were retrospectively divided into either the control group (only DME) or the experimental group (DME and VMIA) based on optical coherence tomography images. We defined VMIA patterns as epiretinal membrane and/or anomalous vitreomacular adhesion. Changes in central macular thickness (CMT), total macular volume (TMV), and best-corrected visual acuity (BCVA) from the baseline to post third injection were compared between the two groups. After the third injection, the decreases in CMT and TMV were not statistically different between the two groups. The improvement in BCVA was larger in the control group (0.1742 ± 0.0508 logMAR) than in the experimental group (0.0766 ± 0.0562 logMAR; p < 0.01). Our study showed that after the third anti-VEGF injection, the BCVA of patients with both DME and VMIAs improved significantly less than that of patients with only DME. Our results suggest that VMIAs may play a crucial role in reducing the therapeutic effects of anti-VEGF agents.