| ObjectiveComparison of changes in fundus changes,optical coherence tomography(OCT),fluorescence fundus angiography(FFA),Indocyanine green angiography(ICGA)in patients with pathologic myopia choroid neovascularization(pmCNV)before and after anti-VEGF therapy.To analyze the imaging features of Myopic choroid neovascularization and the possible influencing factors of anti-VEGF treatment for visual prognosis.MethodFirst part :Data of patients with pmCNV in our hospital form October 2015 to October 2017 were analyzed retrospectively in 97 cases of 97 eyes.First,the factors of the patients was recorded:gender,age,fundus condition,intraocular pressure and related imaging examination,and make a simple descriptive statistics on it.Secondly,analysis of the correlation of imaging features of OCT,FFA and ICGA in the study group.The second part:Retrospective analysis of 48 patients who underwent intravitreal injection and received complete data from October 2015 to October 2017.The factors of the patients was recorded:gender,age,fundus,intraocular pressure,all imaging examinations before and after injection,best corrected-visual acuity.To analyze the improvement of visual acuity after anti-VEGF treatment,the location of lesions and the relationship between OCT morphological changes and visual prognosis.ResultDescriptive analysis of fundus features and distribution in 97 patients,most of these patients were found to be middle-aged and older women.Tessellated retina and staphyloma are the most common fundus changes.A small part of the patients are combined with retinoschisis,consideration related to mechanical pull.In this study,We classify the manifestations of OCT into the following four types:1)Type I:The lesions were spindle-shaped,quasi-circular or irregular reflecting light masses with uneven internal reflection and unclear boundary.;2)Type ? :OCT shows irregular high reflection with surrounding strip-like low-reflection masses,ie with subretinal fluid;3)Type III:Irregularly high reflection with surrounding strip-like low-reflection masses with rounded low-reflection clusters above,ie with subretinal fluid and retinal fluid;4)Type ? :The focus of CNV was homogeneous,with clear boundary and irregular high reflex mass,without internal retinal fluid(and external fluid).We believe that the first three types are active.Type IV is in a stable state,at which time the ellipse zone is not completely continuous.Next,Based on the existing classification of CNV on FFA,we have shown that in this study,In the early stage of FFA,showed patchy strong fluorescence,which gradually leaked over time,and limited strong fluorescence in the late stage of unclear boundary is defined as type ?.The non-leakage type of FFA is defined as type ?.Finally,the image analysis of ICGA is also divided into focal Spots(hot spots),plaques,combination Lesions(various lesions in which both focal spots and plaques are present)and other lesions according to the appeal.Comparing and describing the three kinds of imaging data,it is concluded that in the research group's 97 eyes,In patients with FFA type ?,most of the OCT findings were active,Only a few are stable,there was no obvious specificity of ICGA.In patients with FFA type ?,all the OCT showed stability,this type of ICGA also showed no obvious specificity.The visual acuity of most patients after anti-VEGF treatment has been improved.Visual prognosis changes at different lesion locations were statistically significant(P=0.000).According to the location of the lesion,we divided the patients in this study into a sub-concave(11 eyes),22.92%;a paracentral(15 eyes),31.25%;and a foveal(22 eyes),45.83%.Different lesion locations and visual acuity changes after treatment are relevant(P=0.000).As far as the follow-up time after treatment is concerned,Visual changes at different times were statistically significant(P=0.000).The average visual acuity change after treatment of the central concave type is the largest.According to a line chart of the relationship between the location of the disease and the prognosis of vision,The sub-concave had the best vision at 2months after treatment,The paracentral has the best vision one month after treatment,The foveal has the best vision 6 month after treatment.For OCT after anti-VEGF treatment,The band healing rate of ellipsoid zone is faster than that of RPE layer,it can be observed within 1 month after treatment.The continuity recovery of the RPE layer is the best of the three.In most patients,the integrity of RPE is restored about half a year after treatment.ConclusionWith the development of PM,the abnormal changes of retinal choroid are gradually progressing,but the manifestations are different.The morphological changes of OCT in pmCNV patients are closely related to FFA image features.At the first visit,anti-VEGF therapy is feasible when OCT is active.ICGA has no obvious effect.Intravitreal injection of anti-VEGF(Ranibizumab)is safe and effective in the treatment of pmCNV,It is the first choice of treatment at present.The 1+PRN treatment plan is a reasonable and effective solution to reduce the number of injections,reduce the risk of injection,and reduce the cost of treatment.After treatment,the early visual improvement of the foveal lesions was significant,and the long-term visual acuity of the foveal lesions was better.Vision recovery after treatment may be related to the continuity of the ellipsoidal zone.The ellipsoidal zone heals faster than the RPE layer.RPE layer continuity recovery is best... |
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