Conbercept treatment for heart-shaped vascular intertwined nets in macular neovascularization: anti-VEGF drug therapy strategy based on vascular geometry diagnosed by OCTA

Macular neovascularization (MNV), a hallmark of several retinal disorders including ocular trauma and wet age-related macular degeneration, remains a major cause of vision impairment due to the proliferation of abnormal, fragile blood vessels. Anti-VEGF therapies, such as Aflibercept (Eylea), Bevacizumab (Avastin), Brolucizumab (Beovu), Conbercept (Lumitin), Faricimab (Vabysmo), Ranibizumab (Lucentis), and Pegaptanib (Macugen), have significantly transformed MNV management, targeting VEGF to curb this pathological vascular growth. In this report, we describe a 63-year-old male with a history of hypertension and diabetes who developed acute vision loss attributed to MNV secondary to hypertensive retinopathy. Optical coherence tomography angiography (OCTA) revealed unusual heart-shaped, intertwined vascular nets, informing the choice of Conbercept for intravitreal injection. This personalized therapeutic decision led to marked visual improvement over a 12-month period. The case exemplifies the importance of vascular geometry in guiding anti-VEGF selection, supported by existing literature that links specific neovascular geometries to differential drug responsiveness. Conbercept, in particular, proved effective against the complex intertwined nets observed in this patient. These findings emphasize the promise of individualized treatment strategies and the potential of OCTA-based vascular geometry classification as a tool for precision medicine.