Abstract
Objective
To quantify changes in optical coherence tomography angiography (OCTA) parameters
following intravitreal anti–vascular endothelial growth factor treatment for diabetic
macular edema (DME), and to assess associations between pretreatment OCTA parameters
and visual outcomes.
Design
Prospective cohort study.
Methods
Twenty-nine patients with DME received 5 monthly intravitreal injections of aflibercept.
OCTA data obtained at baseline and at 6 months were compared using the Wilcoxon signed-rank
test. OCTA parameters were foveal avascular zone (FAZ) area, FAZ perimeter, FAZ circularity,
vessel density in the superficial vascular plexus (segmented into central, inner,
outer, and full Early Treatment of Diabetic Retinopathy Study [ETDRS] map regions.
Subanalysis divided patients into treatment responders (reduction of central subfield
thickness >50 µm over treatment) and nonresponders. Associations between pretreatment
OCTA parameters and visual acuity outcomes were analyzed using multivariable linear
and logistic regression.
Results
A total of 29 patients were included: 25 patients (86.2%) had nonproliferative diabetic
retinopathy, and 4 patients (13.8%) had proliferative diabetic retinopathy. Vessel
density was reduced in the central (p = 0.004) and inner (p = 0.013) ETDRS map regions. This effect was significant only among treatment responders
(central p = 0.002; inner p = 0.017). Pretreatment OCT and OCTA parameters were not associated with final visual
acuity outcomes.
Conclusion
Following intravitreal aflibercept treatment for DME, there was a significant decrease
in vessel density of the superficial vascular plexus at the central and inner ETDRS
map regions. This was seen only among treatment responders. Observations here are
likely to represent the limits of OCTA technology itself, where pretreatment vessel
density may have been artifactually overestimated by suspended scattering particles
in motion. Pretreatment OCTA parameters did not serve as biomarkers for visual outcome
following anti–vascular endothelial growth factor therapy.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of OphthalmologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema.Ophthalmology. 2010; 117 (Diabetic Retinopathy Clinical Research Network) (e35): 1064-1077
- Changes in the foveal microstructure after intravitreal bevacizumab application in patients with retinal vascular disease.Clin Ophthalmol. 2013; 7: 173-178
- VEGF expression and receptor activation in the choroid during development and in the adult.Invest Ophthalmol Vis Sci. 2006; 47: 3135-3142
- Long-term effect of intravitreal bevacizumab (Avastin) in patients with chronic diffuse diabetic macular edema.Retina. 2008; 28: 1053-1060
- The RESTORE study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema.Ophthalmology. 2011; 118: 615-625
- Pretreatment clinical variables associated with the response to intravitreal bevacizumab (Avastin) injection in patients with persistent diabetic macular edema.Saudi J Ophthalmol. 2010; 24: 133-138
- Factors influencing intravitreal bevacizumab and triamcinolone treatment in patients with diabetic macular edema.Eur J Ophthalmol. 2017; 27: 746-750
- Baseline choroidal thickness as a predictor for response to anti–vascular endothelial growth factor therapy in diabetic macular edema.Am J Ophthalmol. 2015; 159 (e3): 85-91
- Factors associated with changes in visual acuity and central subfield thickness at 1 year after treatment for diabetic macular edema with ranibizumab.Arch Ophthalmol. 2012; 130: 1153
- Disorganization of the retinal inner layers as a predictor of visual acuity in eyes with center-involved diabetic macular edema.JAMA Ophthalmol. 2014; 132: 1309-1316
- Optical coherence tomography angiography in retinal diseases.J Ophthalmic Vis Res. 2016; 11: 84-92
- A review of optical coherence tomography angiography (OCTA).Int J Retina Vitr. 2015; 1: 5
- Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of diabetic retinopathy.Can J Ophthalmol. 2012; 47 (S1–30): S31-S54
- Optical coherence tomography angiography: a comprehensive review of current methods and clinical applications.Prog Retin Eye Res. 2017; 60: 66-100
- Methods and algorithms for optical coherence tomography-based angiography: a review and comparison.J Biomed Opt. 2015; 20100901
- Optical coherence tomography based angiography.Biomed Opt Express. 2017; 8 ([Invited]): 1056-1082
- Diabetic macular oedema: pathophysiology, management challenges and treatment resistance.Diabetologia. 2016; 59: 1594-1608
- Vascular endothelial growth factor acts as a survival factor for newly formed retinal vessels and has implications for retinopathy of prematurity.Nat Med. 1995; 1: 1024-1028
- Angiogenesis as a therapeutic target.Nature. 2005; 438: 967-974
- Targeted deletion of Vegfa in adult mice induces vision loss.J Clin Invest. 2012; 122: 4213-4217
- Molecular and cellular mechanisms of neuroprotection by vascular endothelial growth factor.J Neurosci Res. 2005; 79: 180-184
- Evaluation of the effect of repeated intravitreal bevacizumab injections on the macular microvasculature of a diabetic patient using optical coherence tomography angiography.Case Rep Ophthalmol Med. 2019; 2019: 1-4
- Macular ischaemia: a contraindication for anti-VEGF treatment in retinal vascular disease?.Br J Ophthalmol. 2012; 96: 179-184
- Combination angiostatic therapy completely inhibits ocular and tumor angiogenesis.Proc Natl Acad Sci U S A. 2007; 104: 967-972
- Review on recent trials evaluating the effect of intravitreal injections of anti-VEGF agents on the macular perfusion of diabetic patients with diabetic macular edema.Rev Recent Clin Trials. 2020; 15: 188-198
- Optical coherence tomography angiography analysis of macular vessel density before and after anti-VEGF therapy in eyes with diabetic retinopathy.Int Ophthalmol. 2019; 39: 2361-2371
- OCT Angiography biomarkers for predicting visual outcomes after ranibizumab treatment for diabetic macular edema.Ophthalmol Retina. 2019; 3: 826-834
- Optical coherence tomography angiography in patients with diabetic retinopathy treated with anti-VEGF intravitreal injections: case report.Medicine (Baltimore). 2017; 96: e8379
- Widefield OCT-angiography and fluorescein angiography assessments of nonperfusion in diabetic retinopathy and edema treated with anti–vascular endothelial growth factor.Ophthalmology. 2019; 126: 1685-1694
- Optical coherence tomography angiography analysis of the foveal avascular zone and macular vessel density after anti-VEGF therapy in eyes with diabetic macular edema and retinal vein occlusion.Invest Opthalmol Vis Sci. 2017; 58: 30
- Microperimetry and OCT angiography evaluation of patients with ischemic diabetic macular edema treated with monthly intravitreal bevacizumab: a pilot study.Int J Retina Vitr. 2019; 5: 24
- Evaluation of changes in macular perfusion detected by optical coherence tomography angiography following 3 intravitreal monthly bevacizumab injections for diabetic macular edema in the IMPACT study.J Ophthalmol. 2020; 2020: 1-14
- Acute macular and peripapillary angiographic changes with intravitreal injections.Retina. 2020; 40: 648-656
- Retinal microvasculature and visual acuity after intravitreal aflibercept in diabetic macular edema: an optical coherence tomography angiography study.Sci Rep. 2019; 9: 1561
- OCT angiography study of the macula in patients with diabetic macular edema treated with intravitreal aflibercept.Ocul Immunol Inflamm. 2021; 29: 926-931
- A swept source optical coherence tomography angiography study: imaging artifacts and comparison of non-perfusion areas with fluorescein angiography in diabetic macular edema.PloS One. 2021; 16e0249918
- Multimodal OCT reflectivity analysis of the cystoid spaces in cystoid macular edema.Biomed Res Int. 2019; 2019: 1-9
- Image artifacts in optical coherence tomography angiography.Retina. 2015; 35: 2163-2180
- Suspended scattering particles in motion: a novel feature of OCT angiography in exudative maculopathies.Ophthalmol Retina. 2018; 2: 694-702
- Suspended scattering particles in motion may influence optical coherence tomography angiography vessel density metrics in eyes with diabetic macular edema.Retina. 2021; 41: 1259-1264
- Optical coherence tomographic hyperreflective foci: a morphologic sign of lipid extravasation in diabetic macular edema.Ophthalmology. 2009; 116: 914-920
- Optical coherence tomography angiography.Prog Retin Eye Res. 2018; 64: 1-55
- The importance of signal strength in quantitative assessment of retinal vessel density using optical coherence tomography angiography.Sci Rep. 2018; 8: 12897
Article Info
Publication History
Published online: May 05, 2022
Accepted:
April 8,
2022
Received in revised form:
November 22,
2021
Received:
July 8,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
