ObjectiveTo observe the clinical features of bacillary layer detachment (BALAD) in neovascular age-related macular degeneration (nAMD) and its response to anti-vascular endothelial growth factor (VEGF) therapy. MethodsA retrospective clinical study. From July 2019 to July 2024, 188 patients (188 eyes) with nAMD who were continuously admitted to Tianjin University Aier Eye Hospital and received anti-VEGF drug treatment were included in the study. All eyes underwent best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. Treatment consisted of intravitreal anti-VEGF injections monthly for 3 months, followed by a pro re nata regimen. Based on the presence of BALAD on baseline OCT, eyes were divided into a BALAD group and a control group. BCVA was measured using a standard logarithmic visual acuity chart and converted to the logarithm of the minimum angle of resolution; central retinal thickness (CRT) was measured by OCT. Patients were followed for ≥12 months. Differences in CRT, BCVA, macular neovascularization (MNV) subtypes, and treatment outcomes at 12 months were compared between the two groups. The Scheirer-Ray-Hare test was used for non-normally distributed repeated measures data to compare interactions between time and group for BCVA and CRT; Spearman's rank correlation was used for correlation analysis of continuous variables between groups. ResultsThe number of eyes in the BALAD group and the control group was 33 (17.55%, 33/188) and 155 (82.45%, 155/188) respectively. Among the 33 eyes in the BALAD group, 21 eyes (63.64%, 21/33) had type 1 MNV, among which 18 eyes had polypoid choroidal vascular disease (PCV). There was no statistically significant difference in the gender composition ratio and MNV classification between the two groups of patients (χ2=2.09, 1.87, P＞0.05). There were statistically significant differences in age (t=-2.63), the proportion of PCV (χ2=13.73), and CRT (Z=-3.03) (P＜0.05). Twelve months after treatment, the cystic cavities of 84.85% (28/33) of the affected eyes in the BALAD group subsided. The BCVA of both groups of affected eyes improved over time (H=17.93, P＜0.05), but the overall BCVA of the BALAD group was still worse than that of the control group (H=17.80, P＜0.05). There was a significant difference in the improvement degree of CRT between the two groups (H=43.87, P＜0.05), and only in the control group was a significant positive correlation between BCVA and CRT (r=0.24, P＜0.05). ConclusionsIn nAMD, BALAD is associated with type 1 MNV, particularly the PCV subtype, and may serve as a biomarker for predicting anti-VEGF response. Although the BALAD structure is sensitive to anti-VEGF therapy and readily resolves, the limited functional improvement suggests it may be an imaging indicator of poor prognosis.
Objective To observe the signal intensity and homogeneity of subretinal hyperreflective material (SHRM) in neovascular age-related macular degeneration (nAMD) and preliminarily analyze its relationship with macular neovascularization (MNV) morphology. MethodsA prospective cross-sectional observational study. Forty-six eyes of 46 nAMD patients with SHRM who initially visited Zhongshan Ophthalmic Center, Sun Yat-sen University from January 1, 2022 to March 31, 2023 were enrolled. Optical coherence tomography (OCT) examination was performed according to a standardized protocol, and 3D Slicer software was used for three-dimensional reconstruction of SHRM lesions. Signal intensity was represented by the mean gray value (mGV) of the three-dimensional lesion area, and homogeneity was represented by the standard deviation of gray values (GV-SD). OCT angiography (OCTA) was used to scan the 6 mm×6 mm area of the macula. FIJI and Angio Tool software were used to measure MNV vascular network total area, perimeter, maximum and minimum diameters, maximum vessel diameter, vascular component area, total number of vascular network junctions and endpoints, vessel dispersion, and mean lacunarity. The ratio of maximum to minimum diameter of the vascular network, average vessel length, vessel density, and vessel fractal index were calculated. Using the mean mGV of the total sample as the standard, the eyes were divided into low-density SHRM group (20 eyes) and high-density SHRM group (26 eyes); using the mean GV-SD of the total sample as the standard, the eyes were divided into homogeneous SHRM group (29 eyes) and non-homogeneous SHRM group (17 eyes). The morphological characteristics of MNV between groups were compared. Independent samples t-test or Mann-Whitney U test was used for between-group comparisons; a multivariate regression model was established to analyze independent factors affecting SHRM signal characteristics. ResultsAmong the 46 eyes of 46 patients, there were 26 eyes of 26 males (56.52%, 26/46) and 20 eyes of 20 females (43.48%, 20/26). The mean age was (65.61±7.50) years. The average vessel length and vessel dispersion in the high-density SHRM group and low-density SHRM group were (6.88±4.56), (11.30±6.31) mm−1 and 41.30±67.26, 13.22±11.34, respectively. Compared with the low-density SHRM group, the high-density SHRM group had significantly lower average vessel length (t=2.645) and higher vessel dispersion (t=−2.090), with statistically significant differences (P=0.012, 0.046). Compared with the homogeneous SHRM group, the non-homogeneous SHRM group had significantly higher total area (t=−2.338), maximum diameter (t=−3.137), and minimum diameter (t=−2.173), with statistically significant differences (P＜0.05). The total number of vascular network junctions in the non-homogeneous SHRM group and homogeneous SHRM group were (90.71±67.34) and (49.34±41.91), respectively; the non-homogeneous SHRM group had significantly more junctions than the homogeneous SHRM group, with a statistically significant difference (t=−2.286, P=0.032). Multivariate regression analysis showed that average vessel length was an independent factor affecting SHRM intensity (odds ratio=0.819, 95% confidence interval 0.705-0.951, P=0.009); there were no independent vascular indicators affecting SHRM reflectivity homogeneity (P＞0.05). ConclusionIn nAMD, compared with low-density SHRM, high-density SHRM has significantly lower average vessel length and higher vessel dispersion; compared with homogeneous SHRM, non-homogeneous SHRM has a larger spatial dimension of the vascular network.
ObjectiveTo compare the clinical characteristics of neovascular age-related macular degeneration (nAMD) patients with or without secondary subretinal fibrosis (SF). MethodsA retrospective case-control study. A total of 88 patients (92 eyes) diagnosed with nAMD at Department of Ophthalmology, Xiyuan Hospital of China Academy of Chinese Medical Sciences from January 2020 to January 2024 were enrolled in this study. All eyes underwent best-corrected visual acuity (BCVA), color fundus photography, and optical coherence tomography (OCT) examinations. BCVA was measured using the international standard visual acuity chart and converted to logarithm of the minimum angle of resolution for statistical analysis. SF area was measured on color fundus images. OCT was used to assess the presence of shallow irregular retinal pigment epithelial (RPE) elevation, RPE detachment, ellipsoid zone/external limiting membrane disruption, subretinal fluid and/or intraretinal fluid, thinning of the inner nuclear layer or inner plexiform layer, complete RPE and outer retinal atrophy (cRORA), epiretinal membrane, and suprachoroidal fluid. Device-integrated software measured central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), and the height and width of subfoveal fibrosis in SF eyes. Based on the presence of SF, patients were divided into the SF group (47 eyes) and the non-SF (NSF) group (45 eyes). Baseline characteristics, OCT, and color fundus photography imaging features were compared between groups. Independent samples t tests were used for intergroup comparisons, and multiple linear regression was performed to analyze potential factors influencing SF height. ResultsCompared with the NSF group, the SF group had a longer disease duration, longer symptom onset to initial treatment interval to receiving anti-vascular endothelial growth factor (VEGF) drug treatment, a lower proportion of patients receiving 3 anti-VEGF drug injections within 6 months, worse BCVA, thicker SFCT, higher rates of pigment epithelial detachment and inner nuclear layer or inner plexiform layer thinning, and a lower rate of subretinal fluid (P＜0.05). No significant differences were observed in CRT or the proportions of irregular retinal pigment epithelia, ellipsoid zone/external limiting membrane disruption, cRORA, suprachoroidal fluid, or epiretinal membrane between the two groups (P＞0.05). ConclusionnAMD eyes with secondary SF exhibit distinct OCT imaging features compared to NSF eyes.