nAMD患者抗VEGF治疗前后OCT和OCTA特征性生物标志物与预后相关性分析
Correlation Analysis of OCT and OCTA Characteristic Biomarkers and Prognosis before and after Anti-VEGF Treatment in nAMD Patients
DOI: 10.12677/acm.2025.15102984, PDF,   
作者: 刘睿鹏：内蒙古民族大学第二临床医学院(内蒙古林业总医院)，内蒙古 牙克石；赵全良*：呼伦贝尔市中蒙医院，内蒙古 海拉尔
关键词: nAMD；抗VEGF；OCT和OCTA特征性生物标志物；nAMD； Anti-VEGF； OCT and OCTA Characteristic Biomarkers
摘要: 新生血管性年龄相关性黄斑变性(nAMD)，其患病率随着年龄的增长而逐渐提升，是目前致盲老年人的重要疾病，目前主要的治疗方法是玻璃体内注射抗血管内皮生长因子(抗VEGF)药物，但仍有部分nAMD患者在接受抗VEGF治疗后视力改善程度不理想，既往的一些研究结果显示某些能够在OCT上观测到的生物标志物如视网膜内液(IRF)、椭球体区完整性(EZ)、视网膜下高反射材料(SHRM)、高反射病灶(HF)等，能够OCTA上观测到的生物标志物如脉络膜血管分型等可以用来判断患者抗VEGF治疗后的预后。本文将从nAMD的病理生理机制，nAMD患者的治疗，nAMD患者抗VEGF治疗前后OCT生物标志物与患者视力的相关性，分析nAMD患者OCT和OCTA特征性的生物标志物，帮助患者诊疗。
Abstract: Neovascular age-related macular degeneration (nAMD), whose prevalence gradually increases with age, is a major blinding disease among the elderly population currently. The main treatment method available is intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) drugs. However, some nAMD patients still show unsatisfactory visual improvement after receiving anti-VEGF treatment. Results from previous studies have indicated that certain biomarkers detectable on optical coherence tomography (OCT)—such as intraretinal fluid (IRF), ellipsoid zone integrity (EZ), subretinal hyperreflective material (SHRM), and hyperreflective foci (HF)—as well as biomarkers observable on optical coherence tomography angiography (OCTA) (e.g., choroidal vascular classification) can be used to predict the prognosis of nAMD patients after anti-VEGF treatment. This article will analyze the characteristic biomarkers of nAMD patients on OCT and OCTA by examining the pathophysiological mechanisms of nAMD, the treatment options for nAMD patients, and the correlation between OCT biomarkers (before and after anti-VEGF treatment) and patients’ visual acuity, thereby providing support for the diagnosis and treatment of nAMD patients.
文章引用：刘睿鹏, 赵全良. nAMD患者抗VEGF治疗前后OCT和OCTA特征性生物标志物与预后相关性分析[J]. 临床医学进展, 2025, 15(10): 2065-2070. https://doi.org/10.12677/acm.2025.15102984

参考文献

[1] Fleckenstein, M., Schmitz-Valckenberg, S. and Chakravarthy, U. (2024) Age-Related Macular Degeneration. JAMA, 331, 147-157. [Google Scholar] [CrossRef] [PubMed]
[2] Ferris, F.L., Wilkinson, C.P., Bird, A., Chakravarthy, U., Chew, E., Csaky, K., et al. (2013) Clinical Classification of Age-Related Macular Degeneration. Ophthalmology, 120, 844-851. [Google Scholar] [CrossRef] [PubMed]
[3] Spaide, R.F., Jaffe, G.J., Sarraf, D., Freund, K.B., Sadda, S.R., Staurenghi, G., et al. (2020) Consensus Nomenclature for Reporting Neovascular Age-Related Macular Degeneration Data. Ophthalmology, 127, 616-636. [Google Scholar] [CrossRef] [PubMed]
[4] Korva-Gurung, I., Kubin, A., Ohtonen, P. and Hautala, N. (2023) Visual Outcomes of Anti-VEGF Treatment on Neovascular Age-Related Macular Degeneration: A Real-World Population-Based Cohort Study. Pharmaceuticals, 16, Article 927. [Google Scholar] [CrossRef] [PubMed]
[5] Lai, T., Hsieh, Y., Yang, C., Ho, T. and Yang, C. (2019) Biomarkers of Optical Coherence Tomography in Evaluating the Treatment Outcomes of Neovascular Age-Related Macular Degeneration: A Real-World Study. Scientific Reports, 9, Article 529. [Google Scholar] [CrossRef] [PubMed]
[6] Taha, A.A., Lazar, D., Julin, C., et al. (2023) Use of Optical Coherence Tomography Angiography for the Diagnosis of Age-Related Macular Degeneration. Danish Medical Journal, 70, A12220780.
[7] Chakravarthy, U., Wong, T.Y., Fletcher, A., Piault, E., Evans, C., Zlateva, G., et al. (2010) Clinical Risk Factors for Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis. BMC Ophthalmology, 10, Article No. 31. [Google Scholar] [CrossRef] [PubMed]
[8] Chen, K., Xu, W., Zheng, J., Shen, Y., Ma, J. and Chen, Z. (2020) Angiogenin, FGF-α, and Il-36β Have Higher Expression Levels in Aqueous Humor of nAMD Patients in Comparison to Cataract Patients. BMC Ophthalmology, 20, Article No. 431. [Google Scholar] [CrossRef] [PubMed]
[9] Chen, L., Ma, B., Liu, X., Hao, Y., Yang, X. and Liu, M. (2020) H2O2 Induces Oxidative Stress Damage through the BMP‐6/SMAD/Hepcidin Axis. Development, Growth & Differentiation, 62, 139-146. [Google Scholar] [CrossRef] [PubMed]
[10] Wu, J. and Zhang, J. (2022) Neovascular Remodeling and Subretinal Fibrosis as Biomarkers for Predicting Incomplete Response to Anti-VEGF Therapy in Neovascular Age-Related Macular Degeneration. Frontiers in Bioscience-Landmark, 27, Article No. 135. [Google Scholar] [CrossRef] [PubMed]
[11] Droho, S., Cuda, C.M., Perlman, H. and Lavine, J.A. (2021) Macrophage-Derived Interleukin-6 Is Necessary and Sufficient for Choroidal Angiogenesis. Scientific Reports, 11, Article No. 18084. [Google Scholar] [CrossRef] [PubMed]
[12] Droho, S., Rajesh, A., Cuda, C.M., Perlman, H. and Lavine, J.A. (2023) Cd11c+ Macrophages Are Proangiogenic and Necessary for Experimental Choroidal Neovascularization. JCI Insight, 8, e168142. [Google Scholar] [CrossRef] [PubMed]
[13] Tan, C.S., Ngo, W.K., Chay, I.W., Ting, D.S. and Sadda, S.R. (2022) Neovascular Age-Related Macular Degeneration (nAMD): A Review of Emerging Treatment Options. Clinical Ophthalmology, 16, 917-933. [Google Scholar] [CrossRef] [PubMed]
[14] Mao, J., Chen, N., Zhang, S., Fang, Y., Zheng, Z., Wu, S., et al. (2022) Association between Inflammatory Cytokines in the Aqueous Humor and Hyperreflective Foci on Optical Coherence Tomography in Patients with Neovascular Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy. Frontiers in Medicine, 9, Article ID: 973025. [Google Scholar] [CrossRef] [PubMed]
[15] Lee, H., Ji, B., Chung, H. and Kim, H.C. (2016) Correlation between Optical Coherence Tomographic Hyperreflective Foci and Visual Outcomes After Anti-VEGF Treatment in Neovascular Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy. Retina, 36, 465-475. [Google Scholar] [CrossRef] [PubMed]
[16] Sacconi, R., Sarraf, D., Garrity, S., Freund, K.B., Yannuzzi, L.A., Gal-Or, O., et al. (2018) Nascent Type 3 Neovascularization in Age-Related Macular Degeneration. Ophthalmology Retina, 2, 1097-1106. [Google Scholar] [CrossRef] [PubMed]
[17] Sadda, S., Holekamp, N.M., Sarraf, D., Ebraheem, A., Fan, W., Hill, L., et al. (2022) Relationship between Retinal Fluid Characteristics and Vision in Neovascular Age-Related Macular Degeneration: HARBOR Post Hoc Analysis. Graefe’s Archive for Clinical and Experimental Ophthalmology, 260, 3781-3789. [Google Scholar] [CrossRef] [PubMed]
[18] Ehlers, J.P., Zahid, R., Kaiser, P.K., Heier, J.S., Brown, D.M., Meng, X., et al. (2021) Longitudinal Assessment of Ellipsoid Zone Integrity, Subretinal Hyperreflective Material, and Subretinal Pigment Epithelium Disease in Neovascular Age-Related Macular Degeneration. Ophthalmology Retina, 5, 1204-1213. [Google Scholar] [CrossRef] [PubMed]
[19] Selvam, A., Shah, S., Singh, S.R., Sant, V., Harihar, S., Arora, S., et al. (2024) Longitudinal Changes in Pigment Epithelial Detachment Composition Indices (PEDCI): New Biomarkers in Neovascular Age-Related Macular Degeneration. Graefe’s Archive for Clinical and Experimental Ophthalmology, 262, 1489-1498. [Google Scholar] [CrossRef] [PubMed]
[20] Charafeddin, W., Nittala, M.G., Oregon, A. and Sadda, S.R. (2015) Relationship between Subretinal Hyperreflective Material Reflectivity and Volume in Patients with Neovascular Age-Related Macular Degeneration Following Anti-Vascular Endothelial Growth Factor Treatment. Ophthalmic Surgery, Lasers and Imaging Retina, 46, 523-530. [Google Scholar] [CrossRef] [PubMed]
[21] Faatz, H., Rothaus, K., Ziegler, M., Book, M., Spital, G., Lange, C., et al. (2022) The Architecture of Macular Neovascularizations Predicts Treatment Responses to Anti-VEGF Therapy in Neovascular AMD. Diagnostics, 12, Article 2807. [Google Scholar] [CrossRef] [PubMed]
[22] Tew, T.B., Lai, T., Hsieh, Y., Ho, T., Yang, C. and Yang, C. (2020) Comparison of Different Morphologies of Choroidal Neovascularization Evaluated by Ocular Coherence Tomography Angiography in Age‐Related Macular Degeneration. Clinical & Experimental Ophthalmology, 48, 927-937. [Google Scholar] [CrossRef] [PubMed]
[23] Liu, S., Liu, Y., Wu, X., Wang, H., Jin, Z., Wang, P., et al. (2025) Efficacy and Prognostic Factors of Anti-VEGF Treatment for Neovascular Age-Related Macular Degeneration: An OCTA Imaging-Based Deep Learning Analysis. Photodiagnosis and Photodynamic Therapy, 55, Article 104701. [Google Scholar] [CrossRef] [PubMed]
[24] Park, J.B., Kim, K., Kang, M.S., Kim, E.S. and Yu, S. (2023) Optical Coherence Tomography Angiography Biomarkers in a Bi-Monthly Maintenance Dosing Aflibercept in Patients with Neovascular Age-Related Macular Degeneration. BMC Ophthalmology, 23, Article No. 314. [Google Scholar] [CrossRef] [PubMed]

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