Abstract
IntroductionThe purpose of this study was to evaluate choroidal vascular changes in patients with neovascular age-related macular degeneration (nAMD) treated with aflibercept injection over a 3-month period.MethodsEnhanced depth imaging optical coherence tomography scans of 60 eyes with treatment-naïve nAMD and 60 unaffected fellow eyes were retrospectively analyzed. Data was collected at baseline and after 3 monthly intravitreal injections of aflibercept. The ImageJ software was used to binarize OCT scans and measure total choroid area (TCA), luminal area (LA), and stromal area (SA). Choroidal vascularity index (CVI) was defined as the ratio of LA to TCA.ResultsAfter treatment, subfoveal choroidal thickness (CT) in nAMD eyes significantly decreased from 210. 6 ± 61.6 to 194.6 ± 58.7 μm (P < 0.001), TCA from 1.620 ± 0.502 to 1.500 ± 0.451 mm2 (P < 0.001), LA from 1.075 ± 0.335 to 0.985 ± 0.307 mm2 (P < 0.001), SA from 0.545 ± 0.176 to 0.516 ± 0.153 mm2 (P = 0.005), and CVI from 66.36 ± 2.89 to 65.46 ± 2.87% (P = 0.009). The decrease of CVI after treatment was significantly correlated with baseline CVI (Rs = 0.466, P < 0.001), but not with the change in BCVA and presence of dry macula after treatment (always P > 0.05).ConclusionChoroidal thickness and vascularity significantly decreased after treatment with aflibercept in nAMD eyes. Besides the pharmacologic effect on the neovascular lesion, aflibercept may induce vascular changes also on the underlying choroid.
Highlights
The purpose of this study was to evaluate choroidal vascular changes in patients with neovascular age-related macular degeneration treated with aflibercept injection over a 3-month period
We evaluated the changes within subcomponents of the choroid in eyes with treatment-naïve neovascular age-related macular degeneration (nAMD) at baseline and after intravitreal aflibercept injections
Eyes with nAMD demonstrated a thicker choroid compared with fellow eyes before antiVEGF treatment [24, 25]
Summary
The purpose of this study was to evaluate choroidal vascular changes in patients with neovascular age-related macular degeneration (nAMD) treated with aflibercept injection over a 3-month period. Aflibercept (Eylea; Regeneron, Tarrytown, NY, USA, and Bayer, Leverkusen, Germany) is a recombinant soluble fusion protein consisting of the binding portions of VEGF receptors 1 and 2 fused to the constant region of an immunoglobulin G-1 This agent acts as a decoy receptor for all isoforms of VEGF-A, VEGF-B, and placental growth factor [5, 6]. Other studies did not find any significant changes in CT after intravitreal injections of bevacizumab (Avastin; Genentech, Inc., South San Francisco, USA) [13] and ranibizumab [10, 14, 15] These inconsistencies may be due to some intrinsic limitations of CT measurement, which is affected by numerous factors including age, sex, systolic blood pressure, intraocular pressure, axial length, and refractive error [16, 17]
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