Analysis Of Factors Affecting Short-term Visual Prognosis In Neovascular Age-related Macular Degeneration Treated With Anti Vascular Endothelial Growth Factor Therapy

Objective:To analyze the influencing factors of short-term visual prognosis in neovascular age-related macular degeneration treated with anti-VEGF.Methods:A retrospective analysis was conducted on 67 newly diagnosed nAMD patients（72 eyes）who underwent anti VEGF treatment in the ophthalmology department of Yan’an University Affiliated Hospital from August 2020 to December2022.All affected eyes were treated with intravitreal injection of anti VEGF drugs using a 3+PRN injection regimen.Collect general information,blood biochemical data,as well as the integrity of best corrected visual acuity（BCVA）,intraocular pressure,retinal fovea thickness（CRT）,subretinal hyperreflexes（SHRM）,subretinal fluid（SRF）,internal retinal fluid（IRF）,elliptical zone（EZ）,and external membrane（ELM）of all patients before and after surgery.Following a 3-month follow-up（based on the first intravitreal injection）,the patients were divided into two groups according to the changes in BCVA at 3 months after surgery compared to baseline:the visual acuity improved group（visual acuity improved）and the visual acuity not improved group（visual acuity not improved or decreased）.Compare the differences in general information,blood biochemical indicators,and eye examination indicators between the two groups,and analyze the influencing factors of early postoperative BCVA in nAMD patients.Results:1.Compared with preoperative,nAMD patients have a significant increase in BCVA and a significant decrease in CRT at different time points after surgery（P<0.05）.2.The age and MLR of the group with improved vision were significantly lower than those of the group without improved vision,while the platelet count was significantly higher than that of the group without improved vision（P<0.05）.Compared with the group without improved vision,the proportion of hypertensive patients and those with SHRM in the group with improved vision was lower,while the proportion of those with SRF,continuous ELM,and complete EZ was higher（P<0.05）.3.Compared with preoperative,the vision improvement group showed a significant increase in BCVA and a significant decrease in CRT at different time points after surgery（P<0.05）.Compared with preoperative,the group with no improvement in vision showed a significant decrease in CRT at 2 and 3 months after surgery（P<0.05）.At 1 month,2 months,and 3 months after surgery,the BCVA of the vision improvement group was better than that of the non improved vision group,and the CRT was lower than that of the non improved vision group（P<0.05）.4.Multivariate Logistic regression analysis affecting postoperative 3-month BCVA found that SRF,SHRM,and ELM continuity were independent influencing factors for postoperative 3-month BCVA（OR₁=31.091,95%CI:3.060～315.851;OR₂=0.024,95%CI:0.002～0.250;OR₃=13.435,95%CI:1.480～122.001）.Age,hypertension,platelet count,MLR,and EZ integrity are not independent influencing factors for postoperative 3-month BCVA.5.The incidence of adverse reactions:foreign body sensation in 3 eyes（4.2%）,subconjunctival hemorrhage in 7 eyes（9.7%）,and postoperative intraocular pressure rise in 3 eyes（4.2%）.All cases did not experience serious complications such as infection,endophthalmitis,cataracts,and retinal detachment.Conclusions:1.Continuous injection of anti VEGF drugs into the vitreous cavity has a significant effect on improving patient vision and reducing CRT.2.The factors that affect the early visual prognosis of nAMD patients after anti VEGF surgery include SRF,SHRM,and continuity of ELM.Patients with SRF,no SHRM,and ELM continuity before treatment had a better early visual prognosis than those without SRF,with SHRM,and ELM discontinuity.