Evaluation And Predictors Of Anti-VEGF Treatment Response In Neovascular Age-related Macular Degeneration

Objective:To evaluate anti-VEGF treatment response in neovascular age-related macular degeneration and investigate the predictive factors.Methods:In this retrospective study,43 eyes?41 cases?were included from October 2015 to April 2017.As loading dose,Ranibizumab?0.5mg,0.05ml?or Conbercept?0.5mg,0.05ml?was injected intravitreally once a month for 3 months.Afterwards,retreatments were given if recurrence was shown during monthly follow-up.Finally,we collected data of the 1^st,3^rd,6^thh and 12^th month after the first injection,functional and morphological response were analyzed.Baseline BCVA and CRT were respectively compared with that after treatment.General linear model was used for analysis of predictive factors of visual acuity response.In addition,we analyzed the correlation between the baseline VA and the VA after treatment at each timepoint.Meanwhile,the morphological response after the loading phase were investigated,as well as the potential predictive factors.In addition,we investigated the rate of recurrence and the predictive factors associated with recurrence after anti-VEGF treatment for AMD.Results:The average number of treatment time was 4.7±2.2.All patients were followed for more than 12 months.The baseline BCVA was?0.86±0.45?,and the BCVA at the 1^st,3^rd,6^th and 12^th month were?0.80±0.41?,?0.67±0.39?,?0.73±0.39?and?0.76±0.37?respectively.The statistical significance was revealed among the BCVA of the 3,6 and12 month?t=-3.70?-2.19?-1.77,P<0.05?.The study showed that the cases with presence of IRF at baseline and the disruption of ELM had worse BCVA at 12 month??=0.34?0.33,P<0.05?.There was no significant statistical difference in the functional and morphological response between different medication?P>0.05?.The visual acuity was positively associated with the baseline VA?r=0.62?0.65?0.53?0.50,P<0.05?.While the improvement of VA was negatively associated with it?r=-0.51?-0.55?-0.59?-0.63,P<0.05?.Average CRT after treatment was significantly decreased when compared with the baseline CRT?t=4.46?5.27?5.15?5.42,P<0.05?.Of the 43 eyes,35?81%?eyes showed good morphological response at 1 month after the loading phase,8?19%?eyes displayed poor morphological response.We didn't find any predictive factors associated with morphological response.In addition,of the 43 eyes,40?93%?eyes showed fluid resolution,and 21?53%?eyes recurred when evaluated in the 12^th month.Compared with eyes with worse VA at the resolution time,the odds ratio?OR?of eyes with better VA was 16.7?95%confidence interval:1.22,100??P<0.05?.Conclusion:For wet AMD patients,the effect of anti-VEGF treatment was identified and completation of the loading phase was needed.Worse baseline VA,presence of IRF and the disruption of ELM may predict worse VA after 3 monthly injections.We should pay more attention to eyes with better VA at the time of fluid absorption which may have more chance to experience recurrence.