Abstract:AIM: To explore the long-term efficacy and influencing factors of intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs in patients with choroidal neovascularization secondary to pathological myopia(PM-CNV).
METHODS: Retrospective case control study. The clinical data of 145 patients with PM-CNV who received intravitreal injection of anti-VEGF drugs at Nanshi Hospital of Nanyang from January 2020 to February 2023 were analyzed. The best corrected visual acuity(BCVA)and central macular retinal thickness(CMT)of the patients at different time points before and after treatment were observed. According to the prognosis after 2-year follow-up, the patients were divided into good therapeutic effect group and poor therapeutic effect group. The general data of the two groups of patients were compared, and multivariate Logistic regression analysis was conducted to analyze the related factors affecting the poor therapeutic effect of the patients. A risk prediction model for poor therapeutic effect on PM-CNV patients was constructed based on relevant factors, and the predictive value of this model was evaluated by using the receiver operating characteristic(ROC)curve.
RESULTS: Compared with before treatment, CMT significantly decreased and BCVA significantly increased at 1, 3, 6, 12 and 24 mo after treatment(all P<0.05). Compared with 1 mo after treatment, CMT was significantly decreased and BCVA was significantly increased at 3, 6, 12, and 24 mo after treatment(all P<0.05). Compared with 3 mo after treatment, CMT was significantly decreased and BCVA was significantly increased at 6, 12, and 24 mo after treatment(all P<0.05). Compared with 6 mo after treatment, BCVA significantly improved at 24 mo after treatment(P<0.05). Compared with the good therapeutic effect group, the proportion of patients aged ≥50 years in the poor therapeutic effect group was larger, the disease course was longer, the number of injections was more, the BCVA before treatment was poorer and the CMT was thicker(all P<0.05). Long disease course, large number of injections, low BCVA before treatment, and thick CMT are the related factors for poor efficacy of intravitreal injection of anti-VEGF drugs in patients with PM-CNV(all P<0.05). A combined prediction model was constructed based on influencing factors. The ROC results showed that the area under the curve(AUC)of this combined model for predicting poor therapeutic effect in PM-CNV patients was 0.756(95% CI: 0.678-0.824), with a sensitivity of 86.27%, a specificity of 62.77%, and a Youden index of 0.490. The combined model has good predictive performance.
CONCLUSION: Anti-VEGF drugs can improve visual acuity and reduce CMT in patients with PM-CNV. Among them, long disease course, more injection times, lower BCVA before treatment, and thick CMT are related factors for poor therapeutic effect on patients with PM-CNV.
