Optical coherence tomography angiography analysis of macular vessel density before and after anti-VEGF therapy in eyes with diabetic retinopathy

• Published in: International ophthalmology Vol. 39; no. 10; pp. 2361 - 2371
• Main Authors: Sorour, Osama A., Sabrosa, Almyr S., Yasin Alibhai, A., Arya, Malvika, Ishibazawa, Akihiro, Witkin, Andre J., Baumal, Caroline R., Duker, Jay S., Waheed, Nadia K.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.10.2019; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Analysis of Variance; Angiogenesis Inhibitors - therapeutic use; Angiography; Bevacizumab - therapeutic use; Blood vessels; Density; Diabetes; Diabetes mellitus; Diabetic retinopathy; Diabetic Retinopathy - drug therapy; Diabetic Retinopathy - pathology; Edema; Eye; Eye (anatomy); Female; Fluorescein Angiography - methods; Humans; Immunotherapy; Macula Lutea - blood supply; Macular Edema - drug therapy; Macular Edema - pathology; Male; Medical imaging; Medicine; Medicine & Public Health; Microvasculature; Middle Aged; Monoclonal antibodies; Multivariate analysis; Ophthalmology; Optical Coherence Tomography; Original Paper; Perfusion; Ranibizumab - therapeutic use; Retina; Retinal Vessels - pathology; Retinopathy; Retrospective Studies; Subgroups; Tomography; Tomography, Optical Coherence - methods; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Bevacizumab, diabetic retinopathy; Optical coherence tomography angiography; Proliferative diabetic retinopathy; Ranibizumab; Vessel density; Anti-VEGF; Macular edema; Aflibercept
• ISSN: 0165-5701; 1573-2630; 1573-2630
• DOI: 10.1007/s10792-019-01076-x

Purpose To evaluate changes in macular vessel density following intravitreal anti-VEGF injection in patients with diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Methods In this retrospective case series, optical coherence tomography angiography (OCTA) images from 55 eyes of 35 patients with either DME (46 eyes) or PDR (9 eyes) were included. Macular capillary vessel density at the level of the superficial retinal capillary plexus (SCP), deep retinal capillary plexus (DCP) and total retinal capillary plexus (TCP) before and after anti-VEGF treatment was calculated. Longitudinal changes in vessel density following serial anti-VEGF treatment were analyzed in a subset of eyes. Results Vessel density in the SCP, DCP or TCP was not found to be significantly different after one, two or three intravitreal injections ( p  > 0.05 for all time points). Subgroup analysis revealed no significant change in the DME and PDR subgroups (all p  > 0.05). Multivariate analysis revealed no effect of type of injected anti-VEGF agent or presence of previous treatment on VD measurements (all p  > 0.05). There was no correlation between the anatomic response of DME to treatment and VD measurements. Conclusions In this study, macular vessel density remained statistically unchanged following up to three intravitreal injections of any anti-VEGF agent. This indicates that there may not be an early effect of anti-VEGF treatment on macular vessel density and its effect on macular perfusion may not be a direct change in microvascular flow.