IMR Press / FBL / Volume 27 / Issue 4 / DOI: 10.31083/j.fbl2704135
Open Access Original Research
Neovascular Remodeling and Subretinal Fibrosis as Biomarkers for Predicting Incomplete Response to Anti-VEGF Therapy in Neovascular Age-Related Macular Degeneration
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1 Department of Ophthalmology, Shanghai General Hospital (Shanghai First People’s Hospital), Shanghai Jiao Tong University, 200080 Shanghai, China
2 National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, 200080 Shanghai, China
*Correspondence: 13917311571@139.com (Jingfa Zhang)
Academic Editors: Shikun He and Graham Pawelec
Front. Biosci. (Landmark Ed) 2022, 27(4), 135; https://doi.org/10.31083/j.fbl2704135
Submitted: 20 November 2021 | Revised: 14 March 2022 | Accepted: 23 March 2022 | Published: 20 April 2022
(This article belongs to the Special Issue Recent Advances in Eye and Vision Research)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Purpose: To compare the progression of neovascular remodeling and subretinal fibrosis in neovascular age-related macular degeneration (NVAMD) after anti-vascular endothelial growth factor (VEGF) therapy. Methods: Twenty eyes from 20 patients with subretinal fibrosis complicating NVAMD were retrospectively reviewed. All patients complied with at least three consecutive monthly intravitreal treatments and final follow-up visit at 12 months after the initial anti-VEGF treatment of aflibercept or ranibizumab. Using optical coherence tomography angiography (OCTA), the central macular thickness (CMT), microvascular density in the superficial capillary plexus (SCP), deep capillary plexus (DCP), choroidal neovascularization (CNV) lesions, as well as subretinal fibrotic lesions were compared between baseline and final visit. Results: The mean number for anti-VEGF injections was 4.40 ± 0.88 during the 12 months of follow-up. There was no significant difference in best-corrected visual acuity (BCVA) and vascular density in SCP and DCP (p > 0.05) between baseline and final follow-up. The CMT decreased from 434.95 ± 87.62 μm at baseline to 365.15 ± 78.92 μm at final visit (p = 0.02). Compared with the baseline, the fine vessels, such as capillary tufts, regressed and the relative density of CNV lesion decreased by 19.12% (p = 0.01), while the relative density of the subretinal fibrosis increased approximately 1.21-fold (p = 0.03) at the final follow-up. Conclusions: The progression of neovascular remodeling and subretinal fibrosis may serve as biomarkers to predict incomplete response to anti-VEGF therapy in patients with NVAMD. Subretinal fibrosis complicating NVAMD remains a major obstacle for the management of NVAMD, and anti-VEGF treatment is a potential therapeutic strategy to target neovascular remodeling and subretinal fibrosis as either an additive or alternative therapeutic approach for NVAMD.

Keywords
neovascular age-related macular degeneration
choroidal neovascularization
anti-VEGF
neovascular remodeling
subretinal fibrosis
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