Liu Shihan, Zheng Minming, Sun Huixin, Pan Chunxing, Li Danting, Zhou Xiyuan, Zheng Zheng
Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Med (Lausanne). 2024 Nov 28;11:1451726. doi: 10.3389/fmed.2024.1451726. eCollection 2024.
To evaluate factors affecting visual acuity prognosis in patients with neovascular age-related macular degeneration (nAMD) following anti-vascular endothelial growth factor (anti-VEGF) therapy via intravitreal injection and to identify baseline risk factors for subretinal fibrosis (SF).
A retrospective study of 64 nAMD eyes treated with intravitreal anti-VEGF treatment over 12 months of follow-up was conducted. Demographic and optical coherence tomography characteristics at baseline were recorded to explore the relevant factors affecting visual acuity outcome. Find baseline risk factors for SF development. The primary baseline measures included OCT qualitative and quantitative indicators, and optical coherence tomography angiography (OCTA) quantitative features.
BCVA (logMAR) at 12 months was positively correlated with age ( = 0.258, = 0.040), baseline BCVA ( = 0.749, < 0.001), central macular thickness (CMT) ( = 0.413, < 0.001), subretinal hyperreflective material (SHRM) ( = 0.304, = 0.014), intraretinal fluid (IRF) ( = 0.423, < 0.001), type 2 macular neovascularization (MNV) ( = 0.272, = 0.029), and ellipsoidal zone breaks ( = 0.299, = 0.016), and hyperreflective foci (HF) ( = 0.264, = 0.035). Eyes with SF had worse baseline BCVA ( < 0.001), greater CMT ( = 0.009), and a higher prevalence of IRF ( = 0.005), type 2 MNV ( = 0.001), SHRM ( = 0.012), and HF ( = 0.028). Logistic binary regression analysis showed that baseline BCVA (logMAR) (OR = 0.02, 95% CI: 0.00-0.45, = 0.013), HF (OR = 0.11, 95% CI: 0.01-0.95, = 0.045), and type 2 MNV (OR = 0.08, 95% CI: 0.01-0.88, = 0.039) were independent risk factors of subretinal fibrosis. As for quantitative OCTA parameters, eyes with subretinal fibrosis had a larger microvascular lesion size ( = 0.003), larger vessels area ( = 0.002), higher number of vessel junctions ( = 0.042) and endpoints ( = 0.024), longer total vessel length ( = 0.005), and lower vessel length density ( = 0.042).
This study enplores baseline OCT and OCTA characteristics associated with subretinal fibrosis in nAMD patients. This information can help predict the occurrence and progression of subretinal fibrosis, potentially leading to more personalized treatment approaches for nAMD patients.
评估玻璃体腔注射抗血管内皮生长因子（anti-VEGF）治疗新生血管性年龄相关性黄斑变性（nAMD）患者时影响视力预后的因素，并确定视网膜下纤维化（SF）的基线危险因素。
对64只接受玻璃体腔抗VEGF治疗的nAMD患眼进行为期12个月的随访回顾性研究。记录基线时的人口统计学和光学相干断层扫描特征，以探讨影响视力预后的相关因素。寻找SF发生的基线危险因素。主要基线指标包括OCT定性和定量指标以及光学相干断层扫描血管造影（OCTA）定量特征。
12个月时的最佳矫正视力（BCVA，logMAR）与年龄（r = 0.258，P = 0.040）、基线BCVA（r = 0.749，P < 0.001）、中心黄斑厚度（CMT）（r = 0.413，P < 0.001）、视网膜下高反射物质（SHRM）（r = 0.304，P = 0.014）、视网膜内液（IRF）（r = 0.423，P < 0.001）、2型黄斑新生血管（MNV）（r = 0.272，P = 0.029）、椭圆体带断裂（r = 0.299，P = 0.016）以及高反射灶（HF）（r = 0.264，P = 0.035）呈正相关。发生SF的患眼基线BCVA更差（P < 0.001）、CMT更大（r = 0.009）、IRF（r = 0.005）、2型MNV（r = 0.001）、SHRM（r = 0.012）和HF（r = 0.028）的患病率更高。Logistic二元回归分析显示，基线BCVA（logMAR）（OR = 0.02，95%CI：0.00 - 0.45，P = 0.013）、HF（OR = 0.11，95%CI：0.01 - 0.95，P = 0.045）和2型MNV（OR = 0.08，95%CI：0.01 - 0.88，P = 0.039）是视网膜下纤维化的独立危险因素。至于定量OCTA参数，发生视网膜下纤维化的患眼微血管病变面积更大（P = 0.003）、血管面积更大（P = 0.002）、血管交叉点（P = 0.042）和端点数量更多（P = 0.024）、总血管长度更长（P = 0.005）且血管长度密度更低（P = 0.042）。
本研究探讨了nAMD患者中与视网膜下纤维化相关的基线OCT和OCTA特征。这些信息有助于预测视网膜下纤维化的发生和进展，可能为nAMD患者带来更个性化的治疗方法。
