She Xiangjun, Cai Qiwei, Yao Wangjing, Zhao Shixin, Lv Zhe, Shan Suyan, Tao Jiwei, Zhang Yun
National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 318000, China.
Eye Vis (Lond). 2025 Aug 10;12(1):32. doi: 10.1186/s40662-025-00450-4.
This retrospective study aimed to identify risk factors for subretinal fibrosis (SF) and evaluate the response to anti-vascular endothelial growth factor (anti-VEGF) therapy in patients with myopic choroidal neovascularization (mCNV), with a specific focus on the role of dilated choroidal vessels (DCVs) in disease progression.
In this retrospective study, patients with high myopia (spherical equivalent < -6.0 D, pathological myopia, Asian ethnicity) and active mCNV lesions, diagnosed between 2021 to 2023, were evaluated. The location of DCVs and mCNV was assessed, and macular thickness, submacular choroid thickness, best-corrected visual acuity, CNV area, and flow density were measured at baseline and during follow-up. The presence of posterior staphyloma was evaluated at baseline. SF around the mCNV was evaluated lesions during follow-up. The time to SF detection was recorded using survival analysis. Risk factors for SF were analyzed using Kaplan-Meier and multivariable Cox regression analyses.
A total of 46 eyes from 46 patients were included, with a mean age of 54.17 ± 14.37 years, and a baseline spherical equivalent of 12.36 ± 3.21 D. The logarithm of the minimum angle of resolution for the mean visual acuity was 0.70 (0.40-1.30), and the mean macular thickness was 313.11 ± 63.57 μm at baseline. DCV was detected in 29 of the 46 eyes (63.0%), and the median time to detect SF was 43.41 [95% confidence interval (CI): 37.27-49.55] months. Multivariable Cox regression analysis identified submacular DCV [hazard ratio (HR): 14.93, 95% CI: 5.72-38.91, P < 0.001) and absence of posterior staphyloma (HR: 43.48, 95% CI: 12.15-156.32, P = 0.002) as independent predictors of SF. The presence of DCV under the fovea compared to the peripheral zone achieved a poorer therapeutic response and was prone to progress to SF after anti-VEGF therapy (P = 0.041).
Submacular DCV is associated with poor therapeutic response to anti-VEGF therapy and an increased risk of SF in patients with mCNV.
本回顾性研究旨在确定近视性脉络膜新生血管（mCNV）患者视网膜下纤维化（SF）的危险因素，并评估抗血管内皮生长因子（anti-VEGF）治疗的反应，特别关注扩张的脉络膜血管（DCV）在疾病进展中的作用。
在这项回顾性研究中，对2021年至2023年期间诊断为高度近视（等效球镜＜-6.0 D，病理性近视，亚洲人种）且患有活动性mCNV病变的患者进行了评估。评估了DCV和mCNV的位置，并在基线和随访期间测量了黄斑厚度、黄斑下脉络膜厚度、最佳矫正视力、CNV面积和血流密度。在基线时评估后巩膜葡萄肿的存在情况。在随访期间评估mCNV周围的SF病变。使用生存分析记录SF检测时间。使用Kaplan-Meier和多变量Cox回归分析分析SF的危险因素。
共纳入46例患者的46只眼，平均年龄54.17±14.37岁，基线等效球镜为12.36±3.21 D。平均视力的最小分辨角对数为0.70（0.40-1.30），基线时平均黄斑厚度为313.11±63.57μm。46只眼中有29只（63.0%）检测到DCV，检测到SF的中位时间为43.41[95%置信区间（CI）：37.27-49.55]个月。多变量Cox回归分析确定黄斑下DCV[风险比（HR）：14.93，95%CI：5.72-38.91，P＜0.001]和无后巩膜葡萄肿（HR：43.48，95%CI：12.15-156.32，P=0.002）是SF的独立预测因素。与周边区域相比，黄斑中心凹下存在DCV在抗VEGF治疗后获得的治疗反应较差，且易于进展为SF（P=0.041）。
黄斑下DCV与mCNV患者抗VEGF治疗的治疗反应差和SF风险增加相关。
