Mechanism-based treatment approaches for neovascularization in retinal diseases: a cohort study

BACKGROUND: Neovascularization is a hallmark of many retinal diseases, including diabetic retinopathy, age-related macular degeneration, and retinopathy of prematurity. Nevertheless, optimal criteria for quantifying the retinal status are currently being searched to help decide whether to initiate and continue anti-angiogenic therapy or perform retinal laser photocoagulation.

AIM: The study aimed to identify the selective criteria for treatment methods based on the type of pathological vasculogenesis in retinopathy of prematurity, vision quality, visual field indices, and morphological and structural parameters in patients with age-related macular degeneration and diabetic retinopathy.

METHODS: A single-center, prospective, cohort study was conducted. The study enrolled patients with diagnosed retinopathy of prematurity (group 1), diabetic retinopathy (group 2), or age-related macular degeneration (group 3). The analysis included data of automated perimetry (mean deviation [MD] and pattern standard deviation [PSD]), optical coherence tomography, including optical coherence tomography angiography, and visual acuity measurement using the revised ETDRS (Early Treatment of Diabetic Retinopathy Study) chart with Russian optotypes for patients in groups 2 and 3. In addition, fractal analysis (Df) was performed and the complexity of retinal vascular networks (RVN) was assessed in all groups.

RESULTS: The study included 219 children (428 eyes) with retinopathy of prematurity in group 1, 70 patients (140 eyes) with diabetic retinopathy in group 2, and 64 patients (109 eyes) with neovascular age-related macular degeneration in group 3. Control groups included 60 patients (120 eyes) for group 1 and 16 patients (32 eyes) for groups 2 and 3 each. Retinopathy of prematurity in group 1 regressed after retinal laser photocoagulation and anti-angiogenic therapy (23 patients [38 eyes] were followed-up), therefore the Df and ΔRVN values can be used as criteria for treatment success. For example, ΔDf of < 0.06 ± 0.015 in stage 3 plus disease and < 0.08±0.02 in aggressive posterior retinopathy of prematurity and ΔRVN of < 0.43 ± 0.08 and < 0.4 ± 0.04, respectively, can be predictors of the need for repeated anti-angiogenic injections or switch to retinal laser photocoagulation. Retinal vascular network parameters in group 2 did not change significantly after retinal laser photocoagulation, which is probably explained by slow regression of pathological changes. Optical coherence tomography angiography revealed that Df tended to increase with a decrease in macular neovascularization activity from 1.5871 ± 0.05 to 1.6462 ± 0.08 (p = 0.13) in patients with neovascular age-related macular degeneration.

CONCLUSION: Df and retinal vascular network parameters can be used to evaluate the effectiveness of retinal laser photocoagulation in patients with retinopathy of prematurity and diabetic retinopathy and to assess activity of the choroidal neovascular membrane in age-related macular degeneration.