| Part1:A comparative study of pathological myopic choroidal neovascularization and macular morphology and microcirculation index in patients with different agesPurpose Use optic coherence tomography angiograph(OCT/OCTA)to compare different ages pathological myopia choroidal neovascularization(PM-CNV)patients’parameters of macular morphology and microcirculation.To provide evidence for the pathogenesis and treatment of clinical PM-CNV.Methods The patients enrolled in the study were diagnosed with PM-CNV in the Northern Jiangsu People’s Hospital from December 2019 to November 2022,there were a total of 70 patients and 70 eyes.They were divided into the young group(≤50 years old)include 18 cases 18 eyes,and the elderly group(>50 years old)include 52 cases 52 eyes.Routine ophthalmic examination and OCT/OCTA examination were examined for all eyes,which collected basic characteristics of the patient and indicators about macular morphology,macular microcirculation and choroidal neovascularization(CNV).The basic characteristics include:age,sex,best-corrected visual acuity(BCVA),diopter,and axis of eye.Macular morphology index include:central macular thickness(CMT),subfoveal inner retinal thickness(IRT),subfoveal outer retinal thickness(ORT),subfoveal choroidal thickness(SFCT)and integrity of the subfoveal outer retinal structure,which includes the Bruch’s membrane,the chimeric band.Microcirculation indicators include superficial capillary plexus vessel density(SCP-VD),deep capillary plexus vessel density(DCP-VD),choroid capillary vessel density(CC-VD).CNV related indicators include:the area of CNV,the area of CNV’s blood flow,the location of CNV.To analyze the different of macular retinal morphology and microcirculatory parameters between the two groups.The independent sample t-test was used to satisfy the normal distribution.Rank sum test was used for variables that did not conform to normal distribution and categorical variables.Results1.There were no significant differences in BCV A,diopter and ocular axis between the two groups(P=0.164,P=0.556,P=0.587).2.The young group’s SFCT(79.00(51.25,112.25)μm)were significantly higher than the elderly group’s(39.50(23.50,63.00)μm)(P<0.001),and there were no statistical differences in CMT,IRT,ORT and the morphology of subfoveal chimeric zone and Bruch membrane between the two groups(P>0.05).3.The young group’s SCP-VD(40.759±4.749%)were significantly higher than the elderly group’s(35.246±6.242%)(P=0.001),and there were no statistical differences in DCP-VD,CC-VD and CNV related indicators between the two groups(P>0.05).Conclusions1.The subfoveal choroid thickness of young PM-CNV patients was significantly higher than that of elderly patients.2.The subfoveal superficial capillary plexus vessel density of young PM-CNV patients was significantly higher than that of elderly patients.Part2:Effects of anti-VEGF drugs on macular morphology and microcirculation in pathologically myopic choroidal neovascularization patients of different agesPurpose To evaluate the effects of intravitreal injection of anti-vascular endothelial growth factor(VEGF)on macular morphology and microcirculation in pathological myopia choroidal neovascularization PM-CNV patients of different ages.Methods The patients enrolled in the study were diagnosed with PM-CNV in the Northern Jiangsu People’s Hospital from December 2019 to November 2021,there were a total of 41 patients and 41 eyes.They were divided into the young group(≤50 years old)include 12 cases 12 eyes,and the elderly group(>50 years old)include 29 cases 29 eyes.All patients received intravitreal injection of anti-VEGF drugs,including 24 patients who received intravitreal injection of 0.5mg Conbercept(10mg/ml)and 17 patients who received intravitreal injection of 0.5mg Ranibizumab(1Omg/ml).Patients used 1+PRN treatment regimen and were followed up for one year.The two groups of patients were analyzed indexes before treatment and one year after treatment,which included best-corrected visual acuity(BCVA),CNV area,CNV blood density,subfoveal choroid thickness(SFCT),central macular thickness(CMT),subfoveal inner retina thickness(IRT),subfoveal outer retina thickness(ORT),superficial capillary plexus vessel density(SCP-VD),deep capillary plexus vessel density(DCP-VD)and choroid capillary vessel density(CC-VD).Independent sample t test was used for those conforming to normal distribution,while Mann-Whitney U test was used for those not conforming to normal distribution between the two groups.The paired t-test was used for the comparison of normal distribution,while Paired rank sum test was used for those not conforming to normal distribution before and after treatment in the same group.Chi-square test was used for categorical variables.Results1.Before treatment,there were no significant differences in diopter number,ocular axis and BCVA between the two groups.One year after treatment,both groups achieved significant visual improvement(0.247±0.335 vs 0.616±0.381,0.435±0.205 vs 0.668±0.337)(P=0.001,P=0.001),and the eyesight of the young group is obviously better than that of the old group(0.247±0.335 vs 0.435±0.205)(P=0.048).2.One year after treatment,the CMT and ORT of the youth group and the elderly group were significantly lower than before treatment(P<0.05),CNV area and CNV blood flow area were significantly reduced compared with before treatment(P<0.05),and there was no significant difference between IRT,DCP-VD and CC-VD compared with before treatment(P>0.05).3.Before treatment,SFCT and SCP-VD in young group were significantly higher than those in old group(P=0.001、P=0.001),One year after treatment,the increase degree of SFCT in youth group was significantly higher than that in old group(9.00(3.00,22.00)μm vs 2.00(-5.00,8.50)μm)(P=0.047),and there were no significant differences in SCP-VD,CMT,ORT,IRT,DP-VD,CC-VD and CNV between the two groups.(P>0.05)4.The number of injections in a year in the youth group were less than that in the older group(1.083±0.289 vs 1.793±0.978),the difference was statistically significant.(P=0.010)Conclusions1.One year after anti-VEGF treatment,the vision of both young and old PM-CNV patients was significantly improved,and the vision prognosis of young patients was better,and the number of intravitreal injection of anti-VEGF drugs was less within one year.2.One year after anti-VEGF treatment,the thickness of macular fovea and outer retina decreased significantly in young and old PM-CNV patients,and the CNV area and blood flow area decreased significantly.The hypofoveal choroid thickness increased more significantly in young patients,while the changes in retinal and choroid blood flow indexes were not obvious. |
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