Neovascularization Type May Predict Prognosis in Patients With Neovascular Age-Related Macular Degeneration

Patients who have neovascular age-related macular degeneration (nAMD) with type 2 or mixed-type neovascularization (NV) respond better to anti-vascular endothelial growth factor (anti-VEGF) therapy than those with type 1 NV, according to research published in Eye and Vision. Findings also revealed that greatest vascular caliber (GVC) shrinkage may be an indicator for predicting a successful response to anti-VEGF treatment. 

Researchers enrolled 60 patients (mean age 70.8 ± 9.6 years, 35 men) with nAMD in an analysis to determine whether certain choroidal neovascularization (CNV) characteristics could predict the prognosis of nAMD following anti-VEGF treatments. They administered anti-VEGF therapy for 3 consecutive months and then switched to a pro re nata (PRN) regimen. The team performed comprehensive ophthalmic examinations, including best-corrected visual acuity (BCVA), dilated examinations with fundus photography, fluorescein angiography (FA), indocyanine green angiography, spectral-domain optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCTA). They conducted follow-up evaluations for at least 6 months following the initial injection.

The investigators stratified participants into NV types. They defined type 1 (n=32) as NV located beneath the retinal pigment epithelium (RPE) layer and above Bruch’s membrane. Type 2 (n=11) involved NV above the RPE, and mixed-type (n=17) involved a combination of type 1 and 2 NV.  

Researchers defined “responders” as having an improvement of 5 or more letters on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart, a central retinal thickness reduction of 25% or greater, or the alleviation of subretinal fluid, intraretinal fluid, or intraretinal cysts at 6 month follow-up. Among the cohort, they classified 39 participants as responders and 21 as non-responders to anti-VEGF therapy. They noted that the proportion of CNV types was significantly different between responders and non-responders (P =.009). Patients with type 2 or mixed NV were more likely to respond to the treatment (28.2% vs 0.0%, and 30.8% vs 23.8%, respectively). The change in GVC also showed a significant difference between responders (−4.98±17.17 μm) and non-responders (11.01±14.10 μm) after 3 intravitreal injections. 

“GVC variations under OCTA, along with CNV type, could be potential biomarkers for estimating long-term anti-VEGF response and facilitating the selection of an optimal regimen after the loading doses of anti-VEGF injections,” according to the investigators. “Focusing on GVC variations after a loading dose of anti-VEGF injections may supplement the current retreatment criteria and help optimize the treatment regimen for nAMD.”

Study limitations include the exclusion of individuals with type 3 NV.

Reference

Jia H, Lu B, Zhao Z, et al. Prediction of the short-term efficacy of anti-VEGF therapy for neovascular age-related macular degeneration using optical coherence tomography angiography. Eye Vis (Lond). Published online May 1, 2022. doi:10.1186/s40662-022-00287-1