Observing OCT Angiography To Detect The Morphological Changes Of CNV Vascular Response To Vegf In The Treatment Of Neovascular AMD

Objective: To analyze the characteristics of choroidal neovascularization(CNV)using optical coherence tomography angiography(OCTA)before and after anti–vascular endothelial growth factor(VEGF)therapy by intravitreal injection(IVR)in neovascular age-related degeneration(n AMD).Methods: 30 cases(38eyes)of n AMD patients diagnosed and hospitalized in the Department of ophthalmology of Shengjing Hospital affiliated to China Medical University from November 2017 to December 2018 were enrolled prospectively in this study.IVR of Ranibizumab(0.5mg/0.05m1)was given to all the patients with 3+PRN.OCTA was used to image the macular neovascularization within 6 mm×6 mm before and after treatment.Best corrected visual acuity(BCVA),central macular thickness(CMT),choroidal neovascularization(CNV)height,CNV greatest linear diameter(GLD),CNV area and CNV density were analyzed.OCTA images of morphological characteristics was evaluated to indicate vascular activity in CNV lesions,and its correlation with CNV lesion quantitative parameters and OCT changes was explored.The quantitative data was analyzed by independent samples t-test and paired sample t test.The qualitative data was analyzed by chi-square test and fisher exact probability method.P < 0.05 was regarded as statistically significant.Results: 1.BCVA(LogMar): BCVA(LogMar)was improved from the baseline mean 0.89 ± 0.58 to 0.56 ± 0.31,the difference was statistically significant(t=2.284,P=0.026).2.CMT: CMT was decreased from baseline mean 354.71±162.90?m to 257.05±76.31?m,the difference was statistically significant(t=2.217,P=0.030).3.Quantification of lesions: CNV area decreased from the baseline mean 4.39±5.07mm2 to 2.10±2.50 mm2(t=2.259,P=0.028),CNV GLD decreased from baseline mean 2.53±1.59 mm to 1.84±1.05 mm(t=1.991,P=0.051),CNV height decreased from baseline mean 330.11±191.26?m to 204.40±103.51?m(t=1.991,P=0.051),and CNV density average decreased from baseline 0.42±0.15 to 0.26±0.14(t=2.996,P=0.000).4.The morphological features of vascular activity in CNV lesions with OCTA were tiny branching vessels,an anastomotic arcade between peripheral tiny branching vessels,loops(inner anastomoses between tiny vessels)and perilesional hypointense halo.After anti-VEGF treatment,the tiny and capillaries branching vessels in the CNV lesions were resolved,and sparse branch vascular network were consisted of the remaining large branch vessels.5.The relationship between OCTA and OCT before and after treatment for CNV lesion activity: 34 eyes(89.47%)with active lesions and 4 eyes with inactive lesions(10.53%)were diagnosed by OCTA and 32 eyes(84.21%)with active lesions and 6 eyes(15.79%)with inactive lesions by OCT before treatment.The two methods were consistent for activity detection(Kappa value=0.771,P=0.000).After anti-VEGF treatment,21 eyes(55.26%)with active lesions and 17 eyes(44.74%)of inactive lesions were diagnosed by OCTA,18 eyes(47.37%)with active lesions and 20 eyes(52.63%)with inactive lesions diagnosed by OCT.The two methods were consistent for activity detection(Kappa value=0.836,P=0.000).6.Comparison of the changes in the morphological changes and quantitative indicators of CNV lesions before and after treatment in patients with n AMD: Before treatment,34 eyes(89.47%)of active lesions and 4 eyes of inactive lesions(10.53%)were examined by OCTA.After the last treatment,the rate of BCVA of inactive lesions group was higher than that of inactive lesions group,the reduction rate of CNV density,.CMT and CNV area of inactive lesions group were larger than those of inactive lesions group(p=0.007,0.010,0.001,0.006).Conclusion:(1)OCTA results including the area of CNV lesions,GLD,height,and vascular density can be used as the standard indicators for n AMD treatment and follow-up.(2)The vascular morphological features presented by OCTA imaging,such as tiny branching vessels,an anastomotic arcade between peripheral tiny branching vessels,loops(inner anastomoses between tiny vessels)and perilesional hypointense halo can be used as CNV activity markers.(3)Intravitreal injection of Ranibizumab is safe and effective treatment for patients with n AMD by reducing CMT,improving vision.(4)OCT combined with OCTA can be used as standard imaging modality for n AMD treatment and follow-up.