Personalized Approach in Treatment of Neovascular Age-Related Macular Degeneration

Abstract

Background: Age-related macular degeneration (AMD) is a progressive, degenerative disease of the central retina. AMD is subdivided into "dry" (atrophic), "wet" (exudative), and neovascular (nAMD) forms. In recent years, the concepts about nAMD changed with the development of optical coherence tomography-angiography (OCT-A) and intravitreal anti-VEGF treatment. The aim of this study was to define the morphologic type of the neovascular membrane (NVM) before treatment with OCT-A and to register vascular remodeling after treatment with anti-VEGF. We also analyzed the relationship between NVM and visual acuity.

Methods: The study was retrospective and included 119 patients with newly diagnosed, treatment-naïve nAMD. All the patients underwent full ophthalmic examination and also fluoresceine angiography and optical coherence tomography-angiography (OCT-A).

Results: Based on the collected data, we found repetitive regularities.

Conclusion: The analysis of our results could be used as prognostic markers for the evolution of the disease and as a basis for new treatment strategies, depending on the naïve NVM morphologic type.

Keywords: AMD; OCT-A; anti-VEGF; approach; neovascularization; personalized; vascular remodeling.

Figure 1

ОСТ-angiography, Eye Clinic ”Zrenie“; Nidek OCT-A RS-3000) Advance 2. (A) NV type “Sea fan”; (B)NV type “Medusa”; (C)NV type “Dead tree”; (D). NV type “Lace”; (E) NV type “Filaments”.

Figure 1

ОСТ-angiography, Eye Clinic ”Zrenie“; Nidek OCT-A RS-3000) Advance 2. (A) NV type “Sea fan”; (B)NV type “Medusa”; (C)NV type “Dead tree”; (D). NV type “Lace”; (E) NV type “Filaments”.

Figure 2

Percentage of naïve morphological type of NVM.

Figure 3

Relationship map: between the naïve type of NV membrane and the type after therapy: The thickness of the line is directly proportional to the strength of the connection. Legend: NV naïve—“naive” form of a neovascular membrane, before therapy; NV post—a form of the neovascular membrane after three intravitreal anti-VEGF applications with an interval one month. 1—Sea fan; 2—Medusa; 3—Dead tree; 4—Lace; 5—filaments; 6—undetermined.

Figure 4

Remodeling NV type “sea fan”, “Medusa”, “dead tree” after therapy.

Figure 5

Relationship map—between the naïve type of NV membrane and the type after therapy—group “differentiated”. The thickness of the line is directly proportional to the strength of the connection. Legend: NV naïve—“naïve” form of a neovascular membrane, before therapy; NV post—A form of the nonvascular membrane after three. intravitreal anti-VEGF applications with a month interval between them. 1—Sea fan; 2—Medusa; 3—Dead tree.