国际眼科纵览 ›› 2026, Vol. 50 ›› Issue (3): 216-223.doi: 10.3760/cma.j.cn115500-20260119-26309

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基于OCT与OCTA预测nAMD抗VEGF应答反应的影像学标志物

屠娇娇1  金昱2   

  1. 1 南昌大学第三临床医学院,南昌 330019; 2 南昌市第一医院眼科,南昌 330008
  • 收稿日期:2026-01-19 出版日期:2026-06-22 发布日期:2026-06-22
  • 通讯作者: 金昱,Email:1043310620@qq.com

Imaging biomarkers for predicting anti-VEGF response in nAMD based on OCT and OCTA

Tu Jiaojiao1, Jin Yu2#br#   

  1. 1 Nanchang University Third Clinical Medical College, Nanchang 330019, China; 2 Department of Ophthalmology, Nanchang First Hospital, Nanchang 330008, China

  • Received:2026-01-19 Online:2026-06-22 Published:2026-06-22
  • Contact: Jin Yu, Email: 1043310620@qq.com

摘要: 新生血管性年龄相关性黄斑变性(neovascular age-related macular degeneration,nAMD)是导致老年人群视力丧失的主要病因之一。尽管抗血管内皮生长因子(anti-vascular endothelial growth factor,VEGF)治疗已成为nAMD的一线方法,但患者的应答反应存在差异。本文系统阐述基于OCT及OCTA的影像学标志物在预测nAMD抗VEGF治疗应答中的价值。视网膜内积液、视网膜下高反射物质、色素上皮脱离、外层视网膜管状结构、较大的黄斑新生血管面积、较高的分形维数及腔隙性,均与治疗应答不良和较差的视力预后相关;而基线存在的视网膜下积液则与较好的视力结局相关。 此外,黄斑区新生血管的定性形态特征(血管环、外周吻合血管弓)有助于判断病灶活动性及预测治疗抵抗。识别上述标志物及其预测价值,有助于早期甄别治疗低反应或无反应人群,调整治疗方案,避免进一步视力损失。

关键词: 新生血管性年龄相关性黄斑变性, 相干光断层扫描, 相干光断层扫描血管成像, 生物标志物

Abstract: Neovascular age-related macular degeneration (nAMD) is a leading cause of vision loss in the elderly population. Although anti-vascular endothelial growth factor (anti-VEGF) therapy has become the first-line treatment for nAMD, patient responses vary considerably. This article systematically reviews the value of OCT and OCTA imaging biomarkers in predicting anti-VEGF treatment response in nAMD. The presence of intraretinal fluid (IRF), subretinal hyperreflective material (SHRM), pigment epithelial detachment (PED), outer retinal tubulation (ORT), larger macular neovascularization (MNV) area, higher fractal dimension (FD), and higher lacunarity are associated with poor treatment response and worse visual prognosis, whereas the presence of baseline subretinal fluid (SRF) is associated with favorable visual outcomes. In addition, qualitative morphological features of MNV, including vascular loops and peripheral anastomotic arches, help assess lesion activity and predict treatment resistance. Identification of these biomarkers and their predictive value may facilitate early recognition of hyporesponders or non-responders, enable adjustment of treatment regimens, and prevent further vision loss.

Key words: Neovascular age-related macular degeneration, Optical coherence tomography, Optical coherence tomography angiography, Biomarker