Abstract
We investigated changes in retinal vascular area and the foveal avascular zone (FAZ) after intravitreal aflibercept in diabetic macular edema (DME) and the association of these changes with visual outcomes. The retinal vascular area in the superficial capillary plexus (SCP) and the deep capillary plexus (DCP) and the FAZ area were measured using optical coherence tomography angiography (OCTA) in 23 eyes of 23 patients with DME, before and after intravitreal aflibercept. Overall, there was no significant change in retinal vascular area or FAZ. Better BCVA after treatment was significantly associated with larger retinal vascular area in the SCP and the DCP, both at baseline (R2 = 0.512, P < 0.001 and R2 = 0.361, P = 0.002, respectively) and after intravitreal aflibercept (R2 = 0.717, P < 0.001 and R2 = 0.618, P < 0.001, respectively). MAs were observed in the DCP in 20 eyes (87%), but only detected in four eyes (17%) in the SCP before treatment. The number of eyes with MAs in the DCP significantly decreased to 13 (57%) after treatment (P = 0.049). The persistence of DME was associated with persistent MAs (P = 0.019) and less visual gain (P = 0.031) following treatment. Thus, preserving retinal perfusion and the resolution of MAs are associated with better vision and resolution of the DME after intravitreal aflibercept.
Highlights
Optical coherence tomography angiography (OCTA) is a novel imaging modality that is able to rapidly and noninvasively visualize retinal blood flow[14,15,16]
Our results reveal that both retinal vascular area and the foveal avascular zone (FAZ) within the 9 (3 × 3) mm[2] area did not significantly differ before and after intravitreal aflibercept treatment in patients with diabetic macular edema (DME)
That is, repeated administration of intravitreal aflibercept with a mean of 2.6 injections over the course of 8.5 months maintained the retinal perfusion at the macula in eyes with DME
Summary
Optical coherence tomography angiography (OCTA) is a novel imaging modality that is able to rapidly and noninvasively visualize retinal blood flow[14,15,16]. OCTA can visualize both superficial and deep capillary plexuses without the use of exogenous dyes. Recent studies have validated that OCTA can objectively measure retinal capillary density in both healthy and diseased eyes, including in patients with DR17–21. Retinal vascular density (VD) with visual acuity in DR has been reported[22,23,24]. Changes in the VD and the FAZ area following anti-VEGF therapy in DME have been reported[25]. Changes in the microvasculature following anti-VEGF therapy and their association with visual changes have not yet been fully elucidated. We assessed the retinal vascular area and the FAZ before and after intravitreal aflibercept injections for DME, and assess the relationship between changes in these measures and visual outcomes
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