Objective To preliminarily investigate the predictive value of volumetric fluctuation index (VFI) of different exudative lesions during anti-vascular endothelial growth factor (VEGF) loading treatment for retreatment requirements within 12 and 24 months in neovascular age-related macular degeneration (nAMD). Methods A prospective cohort study. From January 1, 2022 to March 31, 2023, 46 patients with nAMD who visited State Key Laboratory of Ophthalmology of Sun Yat-sen University for the first time were included in the study. Among them, 35 were male and 11 were female; the average age was (65.61±7.22) years. All patients received a three-times loading treatment followed by on-demand treatment, and were regularly followed up for 2 years. Using optical coherence tomography (OCT), OCT angiography, and 3D Slicer software, three-dimensional reconstructions were performed for seven types of exudative lesions, including subretinal fluid (SRF), intraretinal fluid (IRF), strong reflective substances under the retina [SHRM, including vascular SHRM (vSHRM) and non-vascular SHRM (avSHRM)], and pigment epithelial detachment [PED, including serous (sPED), fibrovascular PED and hemorrhagic PED (hPED)]. Based on the volume data at baseline and 1, 4, 8, and 12 weeks after treatment, the short-term VFI of each lesion was calculated to evaluate its early fluctuation characteristics. According to whether re-treatment was needed within 12 and 24 months after the end of the loading period, the patients were divided into the supplementary treatment group and the stable group. The Mann-Whitney U test was used to compare the differences in VFI between the two groups; a multivariate linear regression model was used to analyze the independent influencing factors of the number of supplementary treatments. Results Among 46 eyes at 12 months post-loading, 17 and 29 eyes were assigned to the retreatment and stable groups, respectively. SRF-VFI and total fluid-VFI were both significantly higher in the retreatment group than in the stable group (Z=3.221, 2.924; P=0.001, 0.003). At 24 months post-loading, 22 and 24 eyes were in the retreatment and stable groups, respectively; total fluid-VFI remained significantly higher in the retreatment group (Z=2.177, P=0.029). Linear regression analyses revealed that, after adjusting for sex, age, macular neovascularization subtype, anti-VEGF drug subtype, and baseline total lesion volume, total fluid-VFI (standardized β=0.382, 0.460) and IRF-VFI (standardized β=0.359, 0.495) were significantly associated with retreatment frequency within 12 and 24 months post-loading (P＜0.05); SRF-VFI and sPED-VFI (standardized β=0.361, 0.392) were significantly associated with retreatment frequency at 12 and 24 months post-loading, respectively (P＜0.05). Total SHRM-VFI and avSHRM-VFI (standardized β=?0.543, ?0.710) were significantly negatively correlated with retreatment frequency within both 12 and 24 months post-loading (P＜0.05); hPED-VFI was significantly negatively correlated with retreatment frequency within 24 months post-loading (standardized β=?0.513, P＜0.05). Conclusions Early volumetric fluctuation patterns can assess long-term treatment requirements in nAMD. Greater total fluid fluctuation predicts more frequent retreatments, while greater SHRM and hPED fluctuation predicts fewer retreatments.

Citation： Pu Jiaxin, Zhuang Xuenan, Hao Xinlei, Wen Feng. Predictive value of short-term volumetric fluctuation index of different exudative lesions for anti-vascular endothelial growth factor retreatment requirements in neovascular age-related macular degeneration. Chinese Journal of Ocular Fundus Diseases, 2026, 42(5): 408-417. doi: 10.3760/cma.j.cn511434-20250912-00393 Copy

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