Birat Eye Hospital, Biratnagar, Nepal.
475231Birat Medical College and Teaching Hospital, Biratnagar, Nepal.
Eur J Ophthalmol. 2022 Sep;32(5):2719-2725. doi: 10.1177/11206721211059349. Epub 2021 Nov 19.
Anti vascular endothelial growth factor (anti VEGF) has been the mainstay of treatment in wet age-related macular degeneration (AMD). Subsequent decision to continue anti VEGF therapy depends on the treatment response quantified by functional (visual acuity) and morphological (optical coherence tomography) parameters then categorized from good to poor.
This study evaluates the agreement between OCT angiography (OCTA) and non-OCTA (logMAR VA plus OCT) to decide anti-VEGF treatment's continuity. After an anti VEGF treatment, on a follow up visit, a patient underwent non-OCTA evaluation (decision A) then OCTA evaluation (decision B) to judge the necessity of future anti VEGF application.
Out of 129 eyes, on 72 eyes (49%), there were agreements on both decision arms, but on 55 eyes (42%) there was disagreement. Particularly, disagreement on 47/55 eyes was important, where OCTA advised "continue anti VEGF" and non-OCTA advised "Stop anti VEGF" therapy. Cohen's Kappa for probability of agreement to continue anti VEGF was fair (0.33) and to stop anti VEGF therapy was none (0.1).
Based on resulting disagreements between the two modalities on deciding the continuity of anti VEGF, we conclude that OCTA must be considered in the conventional decision making algorithm in patients with wet AMD under anti VEGF therapy.
抗血管内皮生长因子（抗 VEGF）一直是治疗湿性年龄相关性黄斑变性（AMD）的主要方法。随后继续抗 VEGF 治疗的决定取决于功能（视力）和形态（光学相干断层扫描）参数的治疗反应，然后从好到差进行分类。
本研究评估了 OCT 血管造影（OCTA）和非 OCTA（logMAR VA 加 OCT）之间的一致性，以决定抗 VEGF 治疗的连续性。在接受抗 VEGF 治疗后，在随访时，患者接受非 OCTA 评估（决策 A），然后进行 OCTA 评估（决策 B），以判断未来是否需要应用抗 VEGF。
在 129 只眼中，有 72 只眼（49%）在两个决策臂上都有一致性，但有 55 只眼（42%）存在分歧。特别是在 47/55 只眼中存在重要的分歧，OCTA 建议“继续抗 VEGF”，而非 OCTA 建议“停止抗 VEGF”治疗。继续抗 VEGF 治疗的概率的 Cohen's Kappa 为中等（0.33），停止抗 VEGF 治疗的概率为零（0.1）。
基于两种方法在决定抗 VEGF 连续性方面的分歧，我们得出结论，在接受抗 VEGF 治疗的湿性 AMD 患者的常规决策算法中，必须考虑 OCTA。
