Purpose The purpose of this study was to evaluate choriocapillaris vascular density changes around macular neovascularization (MNV) before and after anti-vascular endothelium growth factor (VEGF) injections by optical coherence tomography angiography (OCTA). Methods Treatment-naïve eyes with a diagnosis of exudative AMD and type 1 MNV were included. En face optical coherence tomography angiograms were analyzed for percentage of choriocapillaris (CC) flow deficit percentage (FD%), the FD average area (FDa), and the FD number (FDn) in 5 progressive 200-µm-wide concentric rings (R1, R2, R3, R4, and R5) surrounding the dark halo around the MNV. The OCTA acquisition was performed at the following visits: (i) before the loading phase of intravitreal injection of aflibercept or ranibizumab (T1), and (ii) 1 month after the last intravitreal injection of loading phase comprising 3 monthly injections (T2). Results A total of 30 eyes of 30 Caucasian patients with treatment naïve neurovascular AMD (nAMD) were included in the study. All rings showed a progressive FD% reduction at T2 in comparison to T1 values indicating gradual CC reperfusion of the peripheral rings. Furthermore, we found a progressive contraction of the FD average area in all the rings considered ( P < 0.05). On the other hand, at T2, a significant increase in the FD number of the 5 rings was displayed, as compared to T1 ( P < 0.05). Conclusions Our analysis showed topographical CC reperfusion after loading anti-VEGF therapy. CC flow deficits were greater around the associated dark halo before treatment, followed by a progressive recovery of CC flow after intravitreal therapy. Translational Relevance OCTA may be used to assess the development and progression of MNV but also in assessing response to intravitreal injections of anti-VEGF.

The purpose of the study is to explore the morphofunctional fluctuations in eyes treated for neovascular AMD (nAMD) when treatment is switched from aflibercept or ranibizumab to brolucizumab. A total of 31 eyes of 31 patients with nAMD with type 1 macular neovascularization (MNV) were included. All patients were imaged using spectral domain optical coherence tomography (SD-OCT). The OCT acquisition was performed at the following visits: (i) “T1 visit” corresponding to the last follow-up examination in which an intravitreal injection of aflibercept or ranibizumab was performed before switching to brolucizumab because of the lack of improvement and (ii) “T2 visit” corresponding to the examination performed 1 month after T1, the latter visit corresponding to the day when a switch to brolucizumab injection was performed, (iii) and 1 month after the latter injection “(T3)”. The main outcome measures were: (1) central macular thickness (CMT), (2) choroidal vascularity index (CVI), (3) subfoveal choroidal thickness (CT), and best-corrected visual acuity (BCVA). Functional outcome showed significant differences at each time. Mean ± SD BCVA was 0.43 ± 0.12 LogMAR at T1 and 0.56  ±  0.16 LogMAR at T2 (p = 0.038). A significant improvement in BCVA was displayed at T3 (0.34  ±  0.21 LogMAR) as compared with T2 (p  = 0.019). CMT analysis showed fluctuations three times. In detail, T2 displayed a thicker CMT in comparison with T1, although not statistically significant (p = 0.12). Contrariwise, T3 showed a thinner CMT in comparison with T2 (p = 0.002). Analyzing CVI among the three different times, the luminal choroidal area (LCA) and total choroidal area (TCA) showed significantly different values before and after switching to brolucizumab. T2 showed a significant reduction in both vessel lumen and total area compared with T1 (p = 0.032 and p  =  0.046, respectively). Moreover, T3 showed a greater value of both LCA and TCA in comparison with T2 (p = 0.008 and p  =  0.01, respectively). CT did not show significant differences at each time (p > 0.05). Our results reported early experiences on morphofunctional fluctuations in patients with nAMD who switched to brolucizumab. The anatomical impact of brolucizumab administration appears to result in choroidal vascular enlargement, accompanied by the resolution of subretinal fluid (SRF) and intraretinal fluid (IRF).

Purpose: To explore the morpho-functional fluctuations in eyes treated for nAMD when switched from aflibercept or ranibizumab to brolucizumab.Methods: 31 eyes of 31 patients with nAMD with type 1 MNV were included. All patients were imaged using the SD-OCT. The OCT acquisition was performed at the following visits:(I)1 month before the intravitreal injection of aflibercept or ranibizumab (T1),(I) 1 month after T1 and at the time of switch to brolucizumab injection (T2), and 1 month after the latter procedure (T3). The main outcome measures were:(1) Central macular thickness (CMT),(2) choroidal vascularity index (CVI) and,(3) subfoveal choroidal thickness (CT). Results: CMT analysis showed fluctuations at 3 times. In detail,T2 displayed a thicker CMT in comparison to T1, although not statistically significant (p= 0.12). Contrariwise,T3 showed a thinner CMT in comparison to T2 (p= 0.002). Analyzing CVI among the three different times, the LCA and TCA showed significantly different values before and after switching to brolucizumab. T2 showed a significant reduction in both vessel lumen and total area compared to T1 (p= 0.032 and p = 0.046, respectively).Moreover, T3 showed a greater value of both LCA and TCA in comparison to T2 (p= 0.008 and p = 0.01, respectively).CT did not show significant differences at each time (P>0.05)Conclusions: Our results reported early experiences on morpho-functional fluctuations in patients with nAMD switched to brolucizumab. The anatomical impact of brolucizumab administration appears to result in more effective resolution of SRF and IRF, in association with choroidal vascular swelling.