Effect of intravitreal bevacizumab and aflibercept on retrobulbar blood flow in injected and uninjected sound eyes of patients with neovascular age‐related macular degeneration

Abstract

PurposeTo evaluate early changes in retrobulbar blood flow following intravitreal injection of anti‐vascular endothelial growth factor (VEGF) agents.MethodsTen patients affected by neovascular age‐related macular degeneration in 1 eye were enrolled. Five eyes received intravitreal bevacizumab (1.25mg/0.05mL) and 5 eyes aflibercept (2mg/0.05mL). Retrobulbar blood flow was examined by color doppler ultrasonography (Aplio 500, Toshiba Medical System, Tokyo, Japan). Peak systolic velocity (PSV) and resistivity index (RI) was measured from ophthalmic artery (OA), central retinal artery (CRA) and posterior ciliary artery (PCA) in both injected and uninjected sound eyes, before and 21 days after treatment.ResultsBefore and after intravitreal bevacizumab mean retrobulbar blood flow parameters significantly change in PCA: PSV 15.24±3.96 cm/sec vs 12.90±2.63 cm/sec (p=0.0012), RI 0.74±0.02 vs 0.77±0.07 (p=0.009) and in CRA: PSV 14.16±1.8 cm/sec vs 12.29±1.54 cm/sec (p=0.005), RI 0.77±0.03 vs 0.79±0.03 (p=0.029). In the sound fellow eyes, significant changes resulted in PCA: PSV 17.26±3.45 cm/sec vs 13.63±3.3 cm/sec (p=0.003), RI 0.74±0.05 vs 0.79±0.03 (p=0.026). Before and after intravitreal aflibercept measured data significantly change in PCA: PSV 12.8±3.09 cm/sec vs 7.20±0.62 cm/sec (p=0.023), RI 0.68±0.03 vs 0.77±0.03 (p=0.007) and in CRA: PSV 14.28±1.2 cm/sec vs 11.04±0.77 cm/sec (p=0.037), RI 0.73±0.03 vs 0.78±0.05 (p=0.022). In the sound fellow eyes, significant changes resulted in PCA: PSV 12.44±2.89 cm/sec vs 9.18±1.42 cm/sec (p=0.044), RI 0.69±0.05 vs 0.75±0.02 (p=0.028).ConclusionsIntravitreal injections of bevacizumab and aflibercept significantly reduce ocular hemodynamic parameters both in treated and in untreated eyes. These evidences suggest a possible systemic effect.