The peripapillary and macular microvasculature in neovascular age‐related macular degeneration in longterm versus recently started anti‐VEGF using a treat‐and‐extend regimen and healthy controls

Abstract

AbstractPurposeTo investigate alterations in the peripapillary and macular microvasculature in eyes with neovascular age‐related macular degeneration (nAMD) in recently started versus long‐term anti‐vascular endothelial growth factor (VEGF) therapy compared to healthy controls using swept‐source optical coherence tomography angiography–based (OCTA) microangiography (OMAGc).MethodsEyes with nAMD receiving intravitreal anti‐VEGF injections using a treat‐and‐extend regimen (TER) were assigned to group 1 (<5 injections) or 2 (≥20 injections) whereas group 3 constituted the healthy age‐matched controls. Blood flow signals were acquired using PLEX® Elite 9000 Swept‐Source OCTA in 6x6mm scans centered on the fovea and the optic nerve head (ONH). SD‐OCT scans were obtained of the macular and ONH region and the mean ganglion cell complex (GCC) thickness values (retinal nerve fibre layer + ganglion cell layer + inner plexiform layer) were quantified by manual correction. The subgroups were compared using ANOVA.ResultsA total of 80 eyes whereof 40 eyes in the control group were included. Macular superficial perfusion density in the central 3 and 6mm was significantly reduced in group 1 and 2 compared to controls (p < 0.001; p = 0.010) without a significant difference between groups 1 and 2. The presence of subretinal fluid was associated with a better superficial macular perfusion density in the central 6mm (p = 0.036). Mean peripapillary flux index was significantly lower in group 2 than in controls (p = 0.023) in the absence of a significant correlation with neither IOP elevation after the injection nor the number of anti‐VEGF injections received. The mean GGC in the central 3mm was thicker in group 2 compared to group 1 (103.8 µm versus 97.68 µm; p = 0.093), particularly in the inferior part of the macula. An increased pulse pressure was observed in group 2 in comparison to groups 1 and 3 (p = 0.003; p = 0.012).ConclusionsReduced perfusion density of the inner retina might be related to a local vasoconstrictor effect of anti‐VEGF treatment. Neither repeated injections nor postop‐ IOP elevations were correlated to peripapillary microvasculature. The thinning of the IPL observed in nAMD resulting from transsynaptic degeneration of ganglion cell dendrites with photoreceptor loss might regenerate with anti‐VEGF therapy.