Le remodelage vasculaire des néovaisseaux choroïdiens de la dégénérescence maculaire liée à l'âge exsudative, induit par un traitement anti-angiogénique, analysé en OCT-angiographie : reflet des insuffisances des traitements actuels

Abstract : Age-related macular degeneration (AMD) is the first cause of vision impairment in western countries. Its most frequent and severe form, exudative AMD, is the first cause. The advent of intravitreal injections of anti-Vascular Endothelium Growth Factor (anti-VEGF) considerably improved its functional prognosis. However, the variability of therapeutic responses and the cyclic reactivation of choroidal neovascularization highlight the imperfection of current treatments. Because of the partial understanding of its mechanism of action, anti-VEGF therapy led to many publications and pharmacodynamic hypothesis over the last decades, mostly concerning cancer therapy. Vascular blockage was the initial hypothesis.Then, the idea of a vascular normalization came up from the finding that anti-angiogenic treatments increase the effects of ionizing radiation and chemotherapy. Recently commercialized, optical coherence tomography angiography (OCTA) is a noninvasive innovative imaging technique allowing a precise morphological image of choroidal neovascularization. OCTA therefore appears to be an optimal tool to analyse the effects of anti-VEGF on choroidal neovascularization, and by extrapolation on tumor neovascularization. By highlighting a vascular remodelling in OCTA characterized by morphological abnormalities, such as enlarged vessel diameter, paucity of capillaries and large anastomosis, the concept of vascular normalization is called into question. Moreover, OCTA depicts a correlation between neovascular morphology and exudative activity. By shedding light on the precise and acute morphology of choroidal neovascularization for the first time, OCT angiography reveals the strengths and weaknesses of current therapy, and improves our understanding of the mechanism of action of anti-VEGF in the treatment of one of the main causes of world blindness.
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Master Thesis
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Pauline Butori. Le remodelage vasculaire des néovaisseaux choroïdiens de la dégénérescence maculaire liée à l'âge exsudative, induit par un traitement anti-angiogénique, analysé en OCT-angiographie : reflet des insuffisances des traitements actuels. Organes des sens. 2017. ⟨dumas-01623807⟩

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