OCTA观察不同活动性年龄相关性黄斑变性抗VEGF治疗的短期效果

The short-term analysis of different active age-related macular degeneration after anti-VEGF treatment by optical coherence tomography angiography

目的应用相干光断层扫描血管成像(OCTA)观察不同活动性湿性年龄相关性黄斑变性(AMD)患者抗血管内皮生长因子(VEGF)治疗后的应答反应,分析其应答差异性与脉络膜新生血管(CNV)影像学特征的关联性。设计回顾性病例系列。研究对象苏州市立医院北区经荧光素眼底血管造影和吲哚菁绿血管造影明确诊断的湿性AMD患者54例(54眼)。方法根据OCTA检查的黄斑区CNV血管形态将患者分成活动性组(n=34)和非活动性组(n=20)。活动性组平均抗VEGF治疗(4.06±0.89)次,非活动性组平均抗VEGF治疗(3.83±0.79)次。观察两组间抗VEGF治疗前后LogMAR最佳矫正视力(BCVA)及黄斑区中心视网膜厚度(CMT)的差异性。治疗后平均随访(4.17±1.02)个月。主要指标BCVA、CMT。结果活动性组抗VEGF治疗后BCVA(LogMAR)为(0.36±0.12),较治疗前(0.59±0.10)明显改善(t=5.962,P=0.000)。非活动性组抗VEGF治疗后BCVA(LogMAR)为(0.62±0.11),较治疗前(0.70±0.13)无明显改善(t=1.445,P=0.182)。活动性组抗VEGF治疗后CMT为(286.17±97.47)μm,较治疗前的(350.09±131.09)μm明显减少(t=3.792,P=0.001)。非活动性组抗VEGF治疗后CMT为(222.40±34.93)μm,较治疗前的(302.93±132.67)μm明显减少(=2.756,P=0.015)。结论OCTA显示的CNV血管形态学特征能有效评估AMD患者抗VEGF治疗的应答反应,湿性AMD活动性CNV对抗VEGF治疗有良好的应答。

Objective To observe the response of different activity of age-related macular degeneration(AMD)to anti-vascular endothelial growth factor(VEGF)treatment observed by optical coherence tomography angiography(OCTA),and to analyze the correlation between the difference of response and the imaging features of choroidal neovascularization(CNV).Design Retrospective case series.Participants 54 patients(54 eyes)with wet AMD confirmed by fluorescein fundus angiography and/or indocybanine green angiography in Suzhou Municipal Hospital(North District).Methods According to the morphology of macular CNV based on OCTA,AMD patients were divided into active group and inactive group.The average number of anti VEGF was(4.06±0.89)in the active group and(3.83±0.79)in the inactive group.The differences of best corrected visual acuity(BCVA)(LogMAR)and central macular thickness(CMT)before and after anti-VEGF treatment were observed.The average follow-up was(4.17±1.02)months.Main Outcome Measures BCVA,CMT.Result In the active group,BCVA(LogMAR)was(0.36±0.12)after anti-VEGF treatment,which was significantly higher than that before treatment(0.59±0.10)(t=5.962,P=0.000).In the inactive group,the BCVA of patients after anti-VEGF treatment was(0.62±0.11),which was not significantly higher than that before treatment(0.70±0.13)(t=1.445,P=0.182).In the active group,the CMT after anti-VEGF treatment was(286.17±97.47)μm,which was significantly lower than that before treatment(350.09±131.09)μm(t=3.792,P=0.001).In the inactive group,the CMT after anti-VEGF treatment was(222.40±34.93)μm,which was significantly lower than that before treatment(302.93±132.67)μm(t=2.756,P=0.015).Conclusion The morphological features of different active CNV observed by OCTA can effectively assess the response to anti-VEGF treatment in wet AMD patients.Wet AMD patients with active CNV have a good response to anti-VEGF treatment.