Factors influencing the outcome of antiangiogenic therapy for macular neovascularization

Background Macular neovascularization (MN) is one of the leading causes of vision loss in patients over 50 years of age. Treatment of MN with first-line antiangiogenic therapy has a significant effect. However, the therapeutic response may vary among patients. Studying local factors such as anatomical features of the eye, the state of retinal vessels, inflammation, and the level of pigmentation that can affect the effectiveness of therapy is important for optimizing treatment and increasing its effectiveness [1]. Objective To identify local factors that determine the response to first-line antiangiogenic therapy for macular neovascularization. Material and methods The study included 120 patients with macular neovascularization who were treated with antiangiogenic therapy drugs (ranibizumab, aflibercept, bevacizumab) in an ophthalmological center in 2022–2023. Ophthalmoscopy, OCT, fluorescein angiography and ultrasound examination of the eyeball were used to assess local factors. The analysis took into account the following parameters: pigment epithelium density, presence and degree of fibrosis, as well as the anatomy of the choroid [2, 3]. Results The data analysis showed that the success of antiangiogenic therapy directly depends on local factors: retinal thickness, macular pigmentation level and the presence of fibrous changes in the macula. Patients with high pigment epithelium density and minimal fibrous changes showed a significant improvement in visual function, while patients with retinal thinning and the presence of fibrous changes demonstrated a lesser response to therapy; it was also found that more pronounced anatomical changes in the fovea are associated with worse treatment outcomes. Conclusion Local anatomical and vascular features of the eye have a significant impact on the response to antiangiogenic therapy in macular neovascularization. Determination of these factors allows more accurate prediction of treatment effectiveness and individualization of therapeutic strategies. It is important that such parameters as pigment epithelium density, presence of fibrous changes and retinal thickness are taken into account in clinical practice, as this can significantly improve the results of therapy and prevent disease progression. Keywords: macular neovascularization; risk factor; antiangiogenic therapy