抗vegf治疗新生血管性年龄相关性黄斑变性的疗效和预后因素：基于OCTA成像的深度学习分析。

IF 2.6 3区医学 Q2 ONCOLOGY

Photodiagnosis and Photodynamic Therapy Pub Date : 2025-07-17 DOI:10.1016/j.pdpdt.2025.104701

Shengnan Liu , Yuanyuan Liu , Xiaohan Wu , Haochen Wang , Ziqi Jin , Peiru Wang , Jinyu Feng , Song Chen , Wei Zhou

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引用次数: 0

摘要

背景：抗vegf治疗可改善新生血管性年龄相关性黄斑变性（nAMD）患者的视力并降低中央黄斑厚度（CMT）。然而，在我们的研究中，35.76%的患者对抗vegf治疗没有充分的反应。因此，本研究旨在探讨影像学生物标志物，预测nAMD中抗vegf治疗反应的影响因素，以加强临床评价。方法：回顾性分析2018年8月至2023年8月在天津医科大学总医院接受抗vegf治疗的患者资料，其中包括165例渗出性AMD患者。我们调查了他们的性别、年龄、最佳矫正视力（BCVA）（LogMAR）、抗vegf治疗次数、光学相干断层扫描血管造影（OCTA）结果。采用深度学习模型，改进的LUNet模型对OCTA图像进行分析，重点关注视网膜各层（深血管复群和深血管复群）的视网膜特征，包括中央凹无血管区（FAZ）、血管密度（VD）、血管直径指数（VDI）、血管弥散度（Vdisp），评估其与治疗反应的关系。结果：抗vegf治疗6个月后，患者BCVA由0.84±0.40改善至0.70±0.40 (t=2.85， P=0.005)（对应Snellen评分由20/140改善至20/100），CMT由300.16±118.92μm下降至249.53±84.39 μm （t=4.46， P）。MNV Vdisp与抗vegf治疗反应呈正相关；SA、PED与抗vegf治疗反应呈负相关。它允许制定个性化的治疗策略，根据个人风险概况和血管特征量身定制干预措施，从而提高患者的预后。

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Efficacy and prognostic factors of anti-VEGF treatment for neovascular age-related macular degeneration: An OCTA imaging-based deep learning analysis

Background

Anti-VEGF therapies improve visual acuity and reduce central macular thickness (CMT) in neovascular age-related macular degeneration(nAMD) patients. However, In our study, 35.76 % patients do not respond adequately to the anti-VEGF treatment.. Therefore, this study aimed to investigate imaging biomarkers and forecast the influencing factors of anti-VEGF treatment response in nAMD, aiming to enhance clinical evaluation.

Methods

We retrospectively analyzed data from patients treated with anti-VEGF at Tianjin Medical University General Hospital from August 2018 to August 2023, including 165 patients with exudative AMD. We investigated their sex, age, best-corrected visual acuity (BCVA)(LogMAR), number of anti-VEGF treatments, optical coherence tomography angiography (OCTA) results. A deep learning model, the improved LUNet model was used to analyze OCTA images, focusing on retinal features including foveal avascular zone (FAZ), vessel density (VD), vessel diameter index (VDI), vessel dispersion (Vdisp) of retinal layers(deep vascular complex and deep vascular complex) to assess their relationship with treatment response.

Results

After 6 months of anti-VEGF treatment, the patients’ BCVA improved from 0.84 ± 0.40 to 0.70 ± 0.40 (t = 2.85, P = 0.005) (corresponds to an improvement from 20/140 to 20/100 on the Snellen scale.), CMT decreased from 300.16 ± 118.92 μm to 249.53 ± 84.39 μm (t = 4.46, P < 0.001). FAZ perimeter increased from 2.68 mm (2.29, 3.50) to 3.04 mm (2.57, 3.59) (Z=-2.05, P = 0.040), VDI decreased from 6.09 ± 0.83 to 5.90 ± 0.71 (t = 2.33, P = 0.021), central VD decreased (t = 2.21, P = 0.028). Logistic regression showed the Vdisp of macular neovascularization (Vdisp-MNV) (P = 0.007, OR 1.41), Vdisp of deep vascular complex(DVC) (P = 0.006, OR 0.45), neovascular surface area (SA) (P = 0.002, OR 0.26), and pigment epithelial detachment(PED) (P = 0.009, OR 0.29) significantly affected the response to anti-VEGF treatment. There were statistical differences in the association between the base line Vdisp of DVC (b = 0.07, t = 2.50, P = 0.014), base line intraretinal fluid (IRF) (b = 0.17, t = 2.02, P = 0.045) and base line BCVA, shown with multiple linear regression analysis.

Conclusion

This study analyzed factors affecting treatment response. Vdisp in MNV showed positive correlation with anti-VEGF treatment response; SA and PED showed negative correlation with anti-VEGF treatment response. It allowed for making personalized treatment strategy to tailor interventions based on individual risk profiles and vascular characteristics which can enhance patient outcomes.

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来源期刊

Photodiagnosis and Photodynamic Therapy ONCOLOGY-

CiteScore

5.80

自引率

24.20%

发文量

509

审稿时长

50 days

期刊介绍： Photodiagnosis and Photodynamic Therapy is an international journal for the dissemination of scientific knowledge and clinical developments of Photodiagnosis and Photodynamic Therapy in all medical specialties. The journal publishes original articles, review articles, case presentations, "how-to-do-it" articles, Letters to the Editor, short communications and relevant images with short descriptions. All submitted material is subject to a strict peer-review process.