Abstract
The advent of anti-vascular endothelial growth factor (VEGF) therapies has remarkably improved the functional outcomes of neovascular age-related macular degeneration (nAMD) patients. However, there are guidelines on how to start treatment, the guidelines for discontinuing treatment are not yet clear. In this respect, the treat-extend-stop (TES) protocol have showed us the possibility of discontinuing treatment. In this study, we tried to investigate optical coherence tomography angiography (OCTA) biomarkers related to recurrence of neovascular activity in eyes with nAMD undergoing treatment using TES protocol. A total of 134 eyes with nAMD were divided into two groups (stop, non-stop) depending on whether they met criteria for stopping anti-VEGF treatment. Quantitative and qualitative OCTA parameters including the morphologic pattern of choroidal neovascularization (CNV) were compared between groups. Of these, 44 eyes (32.8%) were in the stop group and 90 eyes (67.2%) were in the non-stop group. In multivariate regression analysis, closed-circuit pattern of CNV and the presence of peripheral loop were associated with the non-stop group (all p < 0.001). Our results imply that the morphologic appearance of CNV on OCTA after anti-VEGF treatment may be a useful biomarker to predict weaning from treatment.
Highlights
The advent of anti-vascular endothelial growth factor (VEGF) therapies has remarkably improved the functional outcomes of neovascular age-related macular degeneration patients
Angiogenesis is the major mechanism promoting the progression of neovascular AMD5,6. and the advent of anti-vascular endothelial growth factor (VEGF) therapies has remarkably improved the functional outcomes of patients[7]
Polypoidal choroidal vasculopathy has been shown to have similarities and differences compared with typical neovascular Age-related macular degeneration (AMD) in genetic predisposition, clinical and pathologic characteristics, and response to photodynamic therapy (PDT) or anti–VEGF agents; whether polypoidal choroidal vasculopathy (PCV) is a subtype of AMD or a different clinical entity remains controversial[18]
Summary
The advent of anti-vascular endothelial growth factor (VEGF) therapies has remarkably improved the functional outcomes of neovascular age-related macular degeneration (nAMD) patients. We tried to investigate optical coherence tomography angiography (OCTA) biomarkers related to recurrence of neovascular activity in eyes with nAMD undergoing treatment using TES protocol. Quantitative and qualitative OCTA parameters including the morphologic pattern of choroidal neovascularization (CNV) were compared between groups. The morphologies of CNV associated with neovascular AMD have been extensively described using OCTA, including “sea fan,” “medusa,” “glomerulus-shaped,” “pruned tree,” “vascular loop” and long-term growth patterns[22,23,24]. We aimed to investigate the relationships between en face OCTA morphology and neovascular activity of CNV after anti-VEGF treatment, with the goal of predicting the feasibility of discontinuing treatments
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