Quantitative data analysis of optical coherence tomography angiography of different morphologies of macular neovascularization after intravitreal conbercept versus ranibizumab for neovascular age-related macular degeneration
Authors: Li Jing , Yang Zhufang , Li Xueying , Li Di , Yang Jin , Dang Meijia 
Published: December 2022

AbstractPurposeWe sought to analyze quantitative data findings of optical coherence tomography angiography (OCTA) of different morphologies of macular neovascularization (MNV) in patients with neovascular age-related macular degeneration (nAMD) who received intravitreal conbercept (IVC) or ranibizumab (IVR).MethodsThis was a prospective, interventional case series study and involved 39 patients, including 23 treated with 0.05 mL of conbercept and 16 treated with 0.05 mL of ranibizumab. Patients with MNV were diagnosed with nAMD for the first time at Shaanxi People's Hospital and all were treated with the "3 + PRN" regimen. These MNV cases could be further divided into four OCTA patterns: the “Medusa” pattern, the “tangled” pattern, the “seafan” pattern, and the “other” pattern. Patients were examined using OCTA before (T1) the injection and at 1 day (T2), 7 days (T3), 30 days (T4), 60 days (T5), and 90 days (T6) after anti–vascular endothelial growth factor (VEGF) treatments. Main outcome measures included best-corrected visual acuity (BCVA), MNV vascular area (MNV-VA), MNV vascular density ratio (MNV-VD ratio), and central macular thickness (CMT).ResultsForty-four eyes of 39 patients with nAMD (17 men and 22 women) were included. The average age of participants was 71.34 ± 10.34 years (range, 50–91 years). Twenty-eight eyes (23 patients) received IVC, and 18 eyes (16 patients) received IVR. At 90 days after treatment, the mean BCVAs of patients with the four patterns in the IVC group were improved (P = 0.002); notably, the tangled pattern patients had significantly better results than those with the other three patterns (P = 0.007). Eyes with all four patterns showed significant CMT decreases from the baseline level at 90 days, but there was no significant difference in the total change of CMT between the eyes with different patterns (P = 0.052). The mean MNV-VA and MNV-VD ratios were reduced in all four pattern groups, although the difference of the Medusa pattern was statistically significant for the mean MNV-VA (P = 0.008) but not the mean MNV-VD ratio (P = 0.107). In the IVR group, among the four patterns, the patients with the seafan MNV pattern showed a more significant BCVA improvement (P = 0.042). The mean CMTs of four MNV patterns were decreased after treatment, most notably in patients with the other pattern, but there was no significant difference (P = 0.114). Considering MNV parameters, the mean MNV-VA of the seafan pattern and the mean MNV-VD of the other pattern were significantly decreased, albeit without significant differences (P = 0.225 andP = 0.109). For the comparison between the 2 groups, the mean BCVA, CMT, and MNV parameters were all not significantly different between pre-injection and at the last visit (90 days) after injection.ConclusionsThe distinct morphologies of MNV in nAMD patients can be identified and quantitatively analyzed by OCTA. These different patterns might be useful and instructive predictors for the prognosis of nAMD patients after anti-VEGF therapy. Conbercept for patients with the tangled MNV pattern and ranibizumab for patients with the seafan MNV pattern may be considered as therapeutics.Trial registration numberChiCTR2200056961