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Macular microvascular changes after intravitreal bevacizumab injection in diabetic macular edema

Published:August 05, 2020DOI:https://doi.org/10.1016/j.jcjo.2020.07.004

      Abstract

      Objective

      To evaluate the changes in retinal capillary plexus and the choriocapillaris after a single intravitreal injection of bevacizumab in eyes with diabetic macular edema using optical coherence tomography angiography (OCTA).

      Design

      Prospective interventional case series.

      Participants

      Patients having diabetes with centre-involving diabetic macular edema.

      Methods

      In this prospective interventional case series, eyes with centre-involving diabetic macular edema were enrolled. Vascular density (VD), vascular diameter index (VDI), vascular length density (VLD), foveal avascular zone (FAZ) area, and foveal density (FD)-300 were measured using en face OCTA images before and 1 month after administration of intravitreal bevacizumab. VD and VDI measurements were performed in the superficial capillary plexus (SCP) and deep retinal capillary plexus (DCP) and in the choriocapillaris. Additionally, capillary nonperfusion area (CNPA) was detected automatically based on vessel distance map in 4 concentric rings around the foveal centre. The segmentation error was manually corrected, and the measurements were performed by 2 expert graders.

      Results

      Twenty-three eyes of 19 patients with a mean age of 62.76 ± 6.88 years were included. There were no significant changes in the FAZ area, FD-300, or in the VD of the foveal and parafoveal SCP and DCP. Also, VLD and VDI of the SCP and DCP remained unchanged. The change in the CNPA was not statistically significant. The VD of choriocapillaris increased significantly after injections (p = 0.005).

      Conclusions

      FAZ area and VD of the retinal capillary plexus remained stable in the short-term period after intravitreal bevacizumab. In addition, the choriocapillaris blood flow improved after bevacizumab injection.

      Résumé

      Objectif

      Évaluer, au moyen de l'angiographie-tomographie par cohérence optique (OCT-A, pour optical coherence tomography angiography), les changements enregistrés dans les plexus capillaires rétiniens et la chorio-capillaire après une injection intravitréenne unique de bevacizumab dans l’œdème maculaire diabétique.

      Nature

      Étude d'intervention prospective (série de cas).

      Participants

      Sujets diabétiques présentant un œdème maculaire diabétique central.

      Méthodes

      Dans le cadre de cette étude prospective d'intervention, on a recruté des patients dont les yeux présentaient un œdème maculaire diabétique central. La densité vasculaire (DV), l'indice de diamètre des vaisseaux (IDV), la densité de longueur vasculaire (DLV), l'aire de la zone fovéale avasculaire (ZFA) et la densité fovéale (DF)-300 ont été mesurés grâce à des images en face obtenues à l'OCT-A avant et 1 mois après l'administration intravitréenne de bevacizumab. Les mesures de la DV et de l'IDV ont été réalisées dans les plexus capillaires superficiel (PCS) et profond (PCP) de la rétine de même que dans la chorio-capillaire. De plus, une zone de non-perfusion capillaire (ZNPC) a été automatiquement décelée en fonction de la carte de distance vasculaire dans 4 anneaux concentriques autour du centre fovéal. L'erreur de segmentation a été corrigée manuellement, et les mesures ont été réalisées par 2 examinateurs expérimentés.

      Résultats

      Vingt-trois yeux de 19 patients dont l’âge moyen était de 62,76 ± 6,88 ans ont été retenus. On n'a observé aucune modification significative de l'aire de la ZFA, de la DF-300 ou de la DV dans les PCS et PCP fovéal and parafovéal. La DLV et l'IDV du PCS et du PCP sont également demeurés inchangés. La variation de la ZNPC n’était pas significative sur le plan statistique. La DV de la chorio-capillaire a augmenté significativement après l'injection (p = 0,005).

      Conclusions

      L'aire de la ZFA et la DV des plexus capillaires rétiniens sont demeurés stables à court terme après l'administration intravitréenne de bevacizumab. Qui plus est, le débit sanguin dans la chorio-capillaire s'est amélioré après l'injection de bevacizumab.
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