Analysis Of Retinopathy In Advanced Wet Age-related Macular Degeneration In Patients With Poor Response To Anti-VEGF Therapy

Objective:Analyze retinopathy of the patients with late wet age-related macular degeneration(wAMD)responding poorly to intravitreal injection of anti-vascular endothelial growth factor(anti-VEGF)via Optical coherence tomography(OCT).Methods:A total of 151 patients diagnosed as age-related macular degeneration(Wet age-related macular degeneration,wAMD)in our hospital from September 2017 to September 2019 and treated with intravitreal injection of anti vascular endothelial were included in the study,patients with more than 2 lines were divided into the active group,and patients who had vision less than 0.02 after 6 months or more of treatment were divided into the advanced grooup.On the last visit of each patient in hospital for inspection,the length and height of retinal pigment epithelium detachment,macular fovea thickness,and macular volume were measured by using Optical coherence tomography(OCT),and whether there were subretinal bleeding,retinal cystic effusion,retinal pigment epithelium detachment,subretinal high-signal substances,atrophic scars around the macula,hypochoroidal anterior choroid,discoid scars and other retinopathy were ovserved,and all the data and information which were provided by the study were statistically analyzed.Results:1.The average age of the patients in the active group was 68.02 ± 5.36 years old,and the average age of the patients in the advanced group was 73.85± 4.99 years old.The difference was statistically significant(P<0.001).2.The best-corrected visual acuity of the active group and the late stage group was 0.56 ± 0.34 logMAR and 1.93 ± 0.23 logMAR,respectively,at the last checkup in the hospital(P<0.001).3.The percentage of subretinal hemorrhage,intraretinal hemorrhage,retinal pigment epithelium tears,retinal pigment epithelium detachment,subretinal effusion,intraretinal effusion,subretinal high signal substance,choroidal hyporeflexes,atrophic scar around macula and disciform scars occurred in the active group and the late stage group were10.4%and 37.7%(P<0.001),7.0%and 28.3%(P<0.001),7.0%and 64.2%(P<0.001),90.4%and 100%(P=0.018),53.9%and 30.2%(P=0.004),78.3%and 62.3%(P=0.0039),35.7%and 100%(P<0.001),4.3%and 5.7%(P=0.708),1.7%and 7.5%(P=0.080),9.6%and 90.6%(P<0.001),respectively4.The length and height of RPE detachment,thickness of central macula,thickness of macular fovea and thickness of subretinal high signal substance were compared between the two groups,and P values showed less than 0.001 with statistical significance,while P value of total macula volum and central macular thickness as well as subretinal high signal substance thickness were greater than 0.05,which was not statistically significant.Conclusions:This study suggests that poor responding to anti-VEGF in the patient with wAMD may related to the pathologic changes happened in the eyes including retinal hemorrhage,retinal pigment epithelium tears,thickened retinal hyperreflective signal substance,fibrovascular retinal pigment epithelial detachment and disciform scar etc.observed by OCT...