Imaging Analysis And Treatment Of AMD And PCV

Objective Comparative analysis the consistency and difference of optical coherence tomography angiography(OCTA)and traditional multimodal imaging in patients with age-related macular degeneration(AMD)and polypoidal choroidal vasculopathy(PCV).and observe the characteristic after anti-vascular endothelial growth factor(VEGF)after treatment.By detecting serum index in specific time point before and after the vitreous injection of ranibizumab,to understand the impact of ranibizumab on them,It is hoped this study may play an important role on the treatment of patients with photodynamic therapy combined with anti vascular endothelial growth factor therapy.Methods The clinical data of 150 patients in 170 eyes from November 2015 to 2016 in our hospital were retrospectively analyzed,including the clinical data of 112 patients with AMD in 130 eyes.There were 62 males with 71 eyes and 50 females with 59 eyes.40 patients with PCV were included in the study.Among them,there were 20 males with 21 eyes and 18 females with 19 eyes.All the patients were examined by fundus fluorescein angiography,indocyanine green angiography,frequency domain optical coherence tomography(OCT),and other traditional multi mode fundus imaging and OCTA.The sensitivity and specificity of OCTA in the diagnosis of CNV and its activity were analyzed based on the results of the traditional multi mode imaging,and analysis the sensitivity and specificity of OCTA in diagnosing polypoidal lesion and branch vascular network(BVN)in patients with PCV with different hierarchical in OCTA.Cases were followed up after anti-VEGF treatment.We enrolled patients underwent vitreous injection of ranibizumab in our hospital from October 2016 to February 2017,Fasting blood samples were collected 1 day before the injection,and 1 day and 7 days after the injection,and the total cholesterol(TC),triglyceride(TG),blood glucose,high density lipoprotein(HDL)and low density lipoprotein(LDL)were detected.The results were statistically analyzed.Results 1.The diagnostic value of OCTA for AMD and PCV A total of 130 eyes of 112 consecutive patients was included in this study,Ages ranged from 50 to 91 years,mean age was(68.250±9.789)years.109 eyes were diagnosed as having CNV based on the traditional multimodal imaging,In 103 eyes,CNV was visualized on OCTA.The sensitivity of OCTA for the detection of CNV was 93.6%,with specificity of 95.2%.In patients diagnosed with CNV,73 eyes were diagnosed as group A(active CNV)in traditional multimodal imaging,and the other 36 eyes were group B(inactive CNV).On OCTA in 60 eyes,the lesion was defined as Pattern I and the remaining 49 as Pattern II.The sensitivity of OCTA for the detection of active CNV was 82.2%,with specificity of 100%.In 40 eyes with PCV,a total of 61 polyps were detected in the ICGA,and it is about 50 polyps in the outer retinal layer and 26 polyps in choroid layer in OCTA;ICGA can dectect 40 eyes with BVN,OCTA outer layer of the retina can show BVN in 31 eyes,and choroid layer was 37 eyes.2.The application of OCTA in the follow-up of AMD and PCV after treatment 69 cases of AMD with 69 eyes were followed up,Compared with baseline,BCVA was significantly higher at each time point after treatment(F=3.086,P=0.028),The vascular density and lesion area of chroidal and outer retinal layer of OCTA in initial CNV group decreased significantly after treatment(P<0.05),and there was a negative correlation between BCVA and vascular density and lesion area on OCTA(P < 0.05).While the obsolete group had no significant changes,and there was no correlation between BCVA and vascular density and vascular area on OCTA in this group.The central retinal thickness(CRT)was significantly decreased after treatment(F=7.524,P=0.000).BCVA was significantly correlated with CRT(rp =-0.295,P=0.000).24 cases of PCV were followed up,The overall difference of central choroidal thinckness(CCT)was statistically significant compared with baseline(F=2.881;P=0.040).There was a significant difference in CRT treatment at baseline(F=23.099,P=0.000).There was a negative correlation between BCVA and outer retinal and choroidal vascular density and CRT(rp=-0.492,P=0.023;rp=-0.269,P=0.008,rp=-0.216,P=0.035).3.The influence of ranibizumab on serological parameters in patients with AMD and PCV.A total of 79 people were included in the study of the effects of the ranibizumab on venous blood indexes.There were 45 patients with senile macular degeneration(AMD),34 patients with polypoid choroidal vasculopathy(PCV).In the AMD group,HDL and blood glucose was significantly decreased 1 days after operation(P=0.006、P=0.000),and TG is significantly higher at 1 day after operation than before(P=0.007),In the PCV group,HDL、 LDL、blood glucose、TCwas significantly decreased 1 days after operation(P=0.000、P=0.002、P=0.006、P=0.003),There was no significant difference between both of the groups in the 7 days after operation,compared with the baseline(P > 0.05),and it is the same that there was no significant difference between both of the groups at 1 day after treatment in the first time and second time(P > 0.05).At the same time point,there was no significant difference between the AMD and PCV groups(P > 0.05).Conclusion OCTA and multi mode traditional fundus imaging has significant consistency in diagnosising CNV and it’s activity judgement in patient with exudative AMD.OCTA has definite value in the follow-up of AMD and PCV after treatment.1 days after the injection of ranibizumab,the effect on serum molecular level was great,and the initial level was restored after one week.,It indicated that when it comes to combination therapy in patients with AMD and PCV,it is better to avoid PDT within 7 days after injection of ranibizumab.