Chinese scholars have made new progress in the diagnosis and treatment of age-related macular degeneration

Figure SS-OCTA shows the evolutionary imaging characteristics of the lesion: (A) abnormal branch vascular network growth; (B) enlargement of polypoid lesions; (C) recurrence of polypoid lesions; (D) neonatal polypoid lesions; (e) complete resolution of polypoid lesions; (F) Reduction of polypoid lesions

With the support of the National Natural Science Foundation of China (grant numbers: 81730026, 81970845, 82171076), Professor Sun Xiaodong's research group of the First People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine has made new progress in the diagnosis and treatment of age-related macular degeneration, and found that polypoid choroidal vascular disease (PCV) is a key imaging marker for predicting the recent recurrence of lesions, which can provide an important reference for
the precise treatment and individualized follow-up of age-related macular degeneration 。 The research results, entitled "Progression of polypoidal lesions associated with exudative recurrence in polypoidal choroidal vasculopathy", were published online in the journal Ophthalmology
。 Links to papers: https://doi.
org/10.
1016/j.
ophtha.
2022.
09.
013
.

PCV is the predominant subtype
of neovascular age-related macular degeneration in Asian populations.
Polypoid lesions are characteristic lesions for the diagnosis of PCV, and resolution of polypoid lesions has been one of the main endpoint indicators for clinical evaluation of
treatment effect.
In the current anti-vascular endothelial growth factor treatment guidelines, visual improvement is the main purpose of treatment, and PCV retreatment regimen relies more on the appearance of various effusions in the retina on optical coherence tomography (OCTA) as an indicator of disease activity, which has a relative lag in treatment and ignores the attention
to polypoid lesions.
The previous study of Professor Sun Xiaodong's research group found that the essence of polypoid lesions in PCV is entangled neovascularization, not simple aneurysm-like dilation changes as previously thought, which revealed the essential characteristics of polypoid lesions and provided a scientific basis
for the use of anti-neovascularization in the treatment of PCV 。 On the basis of this study, the research group continued to include 31 patients with PCV treated with anti-vascular endothelial growth factor and/or photodynamic therapy, and used scanning source optical coherence tomography (SS-OCTA) for continuous follow-up, and found that recurrence after treatment was the main reason for poor visual prognosis of PCV patients, and the growth and progression of abnormal branched vascular networks and polypoid lesions were important risk factors for exudative recurrence of PCV lesions.
The median time interval between growth and recurrence of the abnormal branched vascular network is significantly longer than the time interval
between progression and recurrence of polypoid lesions.
The application of SS-OCTA to observe the progression characteristics of polypoid lesions is an important indicator for predicting the recurrence of PCV exudative within 3 months (Fig).

The research group revealed two completely different patterns of PCV lesion evolution and progression, the relapsing group showed a "old disease recurrence" mode, while the non-relapse group showed a "relatively stable" mode, and the lesions could remain stable without recurrence during the follow-up period of up to 20 months, which proved that PCV lesions had different lesion mobility, and reminded clinicians to formulate individualized follow-up treatment strategies
for PCV with different lesion activity 。 The study also proved that polypoid lesions are an important guiding image marker in anti-vascular endothelial growth factor therapy and follow-up management, and continuous follow-up based on the PCV law recorded by OCTA will provide an important reference for its subsequent treatment plan
.