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

Sorour, Osama; Sabrosa, Almyr S.; Alibhai, A. Yasin; Arya, Malvika; Ishibazawa, Akihiro; Witkin, André J.; Baumal, Caroline R.; Duker, Jay S.; Waheed, Nadia K.

doi:10.1007/s10792-019-01076-x

Cited by 63 publications

(54 citation statements)

References 28 publications

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“…In another retrospective study evaluating the effect of repeated intravitreal anti-VEGF injections for treatment of DME or PDR on the macular perfusion using OCTA 3X3 mm and 6X6 mm scan protocols, there was no statistically significant difference in the macular perfusion after 1, 2, and 3 injections using both scanning protocols. 28 Although the study included 46 eyes which performed OCTA after the first injection, only 28 and 26 eyes performed OCTA after the 2 nd and 3 rd injections respectively. Unlike our study, the type of anti-VEGF agent used was variable (45.7% bevacizumab, 42.4% aflibercept, and 11.9% ranibizumab) and the mean interval between injections was 47 days.…”

Section: Discussionmentioning

confidence: 99%

Changes in Macular Perfusion Detected by Optical Coherence Tomography Angiography Following 3 Intravitreal Monthly Bevacizumab Injections for Diabetic Macular Edema in the IMPACT Study

Elnahry

Abdelkader

Raafat

et al. 2019

Preprint

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Background This study was done to evaluate macular perfusion changes following intravitreal bevacizumab injections for diabetic macular edema (DME) using spectral domain optical coherence tomography angiography (SD-OCTA). Methods This study was a prospective noncomparative interventional case series. Treatment naïve patients with DME were recruited at Cairo University retina clinic and underwent full ophthalmological examination and SD-OCTA scanning at baseline and after 3 intravitreal bevacizumab injections. Both the 6X6 and 3X3-mm macular scan protocols were used. Pre and post-treatment OCTA images were automatically aligned using a commercially available retina alignment software (i2k Align Retina software) then the fractal dimension (FD), vascular density (VD), and skeleton VD changes were obtained at the full retinal thickness (Full) and superficial (SCP) and deep (DCP) capillary plexuses after processing images using a semi-automated program. The foveal avascular zone (FAZ) was manually measured and FD was calculated using the FracLac plugin of ImageJ. Results Forty eyes of 26 patients were included. Following injections, there was an 8.1% increase in FAZ, 1.3% decrease in FD-Full and FD-SCP, 1.9% decrease in FD-DCP, 8% decrease in VD-Full, 9.1% decrease in VD-SCP, 10.6% decrease in VD-DCP, 13.3% decrease in skeleton VD-Full, 12.5% decrease in skeleton VD-SCP, and 16.3% decrease in skeleton VD-DCP in the 6X6 mm macular area, and a 2.6% decrease in FD-Full, 3.4% decrease in FD-SCP, 11.5% decrease in VD-Full, 14.3% decrease in VD-SCP, and 25.1% decrease in skeleton VD-SCP in the 3X3 mm macular area which were all statistically significant (p<0.05). There was also an 8.3% increase in the FAZ, 18.5% decrease in skeleton VD-Full, 2.6% decrease in FD-DCP, 8.8% decrease in VD-DCP, and 19.7% decrease in skeleton VD-DCP in the 3X3 mm macular area but these were not statistically significant (p>0.05). Using univariate and multivariate analysis, the pre-treatment FD, VD, and skeleton VD at each capillary layer significantly negatively correlated with the change in FD, VD, and skeleton VD at the corresponding capillary layer respectively (p>0.05). Conclusion OCTA is a useful non-invasive tool for quantitative evaluation of macular perfusion changes following DME treatment. Trial Registration Trial registered at ClinicalTrials.gov on August 11, 2017 (Study ID: NCT03246152).

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Section: Discussionmentioning

confidence: 99%

Changes in Macular Perfusion Detected by Optical Coherence Tomography Angiography Following 3 Intravitreal Monthly Bevacizumab Injections for Diabetic Macular Edema in the IMPACT Study

Elnahry

Abdelkader

Raafat

et al. 2019

Preprint

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“…Other limitations in our study mainly include the small sample size and the short study period. Indeed, a part of studies used OCTA observing changes in macular perfusion and found there is no improvement in FAZ and vessel density after anti-VEGF [34][35][36][37]. The effects of anti-VEGF therapy on DMI need a larger sample size and a longer observation period to determine how anti-VEGF plays a role in improving macular ischemia and retinal ischemia and realizing reperfusion in nonperfusion areas.…”

Section: Discussionmentioning

confidence: 99%

Clinical effect of conbercept on improving diabetic macular ischemia by OCT angiography

et al. 2020

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Background Varying degrees of macular ischemia generally occur in diabetic retinopathy (DR). This study aims to evaluate the effect of conbercept with 3+ pro re nata (PRN) on macular perfusion status in patients with diabetic macular edema (DME) and quantitatively assess changes in foveal avascular zone (FAZ) areas and capillary density in macular regions by applying optical coherence tomography angiography (OCTA). Methods Fifty patients were divided into ischemic (n = 31) and non-ischemic (n = 19) groups according to the presence of ischemia on OCTA at baseline. All patients received intravitreal injections of 0.5 mg of conbercept with 3+ PRN principle. The FAZ areas and macular vessel density measured using OCTA were evaluated at baseline, 3 months, and 6 months after treatment in both groups. Results At months 3 and 6, the FAZ area in the ischemic group changed from 0.510 ± 0.171 mm2 to 0.441 ± 0.158 mm2 then to 0.427 ± 0.153 mm2 (p = 0.003, p = 0.296); in the non-ischemic group, it remained stable (p = 0.269, p = 0.926). The superficial vessel density changed from 41.1 ± 4.1 to 42.5% ± 4.7% then to 42.6% ± 4.6% (p = 0.043, p = 0.812), and the deep vessel density changed from 40.7 ± 4.4 to 42.3% ± 3.6% then to 42.3% ± 4.7% (p = 0.072, p = 0.961) in the ischemic group. In the non-ischemic group, the superficial vessel density changed from 44.8 ± 3.2 to 46.0% ± 3.5% then to 45.7% ± 3.3% (p = 0.108, p = 0.666), whereas the deep vessel density changed from 43.6 ± 3.6 to 43.8% ± 3.2% then to 43.5% ± 4.5% (p = 0.882, p = 0.736). Reperfusion in macular nonperfusion areas was observed. Conclusion Anti–vascular endothelial growth factor treatment may have a positive effect on macular perfusion status. Furthermore, OCTA had advantages in quantifying and calculating blood flow index in the study of macular perfusion status.

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“…OCTA is a non-invasive procedure with depth resolved imaging technique which allows the visualization and quantitation of the CD of super cial and deep retinal capillary plexus as well as choriocapillaris [21,22]. Although FA and ICGA remain invaluable in the diagnosis of many retinal and choroidal diseases, however, both FA and ICGA are invasive procedures need the injection of dye, which are time-consuming, and also carry the risk of complications, such as severe allergic reactions or even death.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Evaluation of Parafoveal Microvasculature Changes in Eyes with Exudative Circumscribed Choroidal Haemangioma : An Optical Coherence Tomography Angiography Study

Lai

Huang

Zhang

et al. 2020

Preprint

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Background: To quantitative evaluation of parafoveal microvasculature changes in eyes with exudative circumscribed choroidal haemangioma (CCH) compared with age- and gender-controlled healthy eyes.Methods: This was a cross-sectional, case-control study. 82 eyes of eighty-two subjects including 41 eyes of forty-one subjects in the exudative CCH group and 41 eyes of forty-one subjects in the age- and gender-controlled healthy eye group were enrolled in this study. Optical coherence tomography angiography (OCTA) was performed in each subject, and the capillary density (CD) of superficial plexus, deep capillary plexus, and the choriocapillaris as well as the area of foveal avascular zone (FAZ) were noted and analyzed between two groups.Results: The CD of the superficial plexus (44.51 ± 3.58 % vs 47.93 ± 2.94%) and deep plexus (47.75 ± 5.60% vs 52.66 ± 5.04%) of retina as well as the vessel density of choriocapillaris (54.42 ± 6.36% vs 61.83 ± 3.65%) significantly decreased in eyes with exudative CCH compared with age- and gender-controlled healthy eyes (all P < 0.001). Although we found that the FAZ areas in the exudative CCH group was larger than that of the healthy eye control group (0.30 ± 0.11mm2 vs 0.27 ± 0.87mm2), however, no statistical significance was found between two groups (P = 0.164).Conclusions: OCTA is a rapid, non-invasive, high-resolution procedure with which could monitor the parafoveal microvasculature changes in eyes with exudative CCH. We found that not only the CD of the superficial plexus and deep plexus but also the CD of choriocapillaris significantly decreased in eyes with exudative CCH compared with age- and gender-controlled healthy eye group.Trial registration: This study was registered on the https://www.clinicaltrials.gov (trial registration number: NCT04449900)

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

Cited by 63 publications

References 28 publications

Changes in Macular Perfusion Detected by Optical Coherence Tomography Angiography Following 3 Intravitreal Monthly Bevacizumab Injections for Diabetic Macular Edema in the IMPACT Study

Changes in Macular Perfusion Detected by Optical Coherence Tomography Angiography Following 3 Intravitreal Monthly Bevacizumab Injections for Diabetic Macular Edema in the IMPACT Study

Clinical effect of conbercept on improving diabetic macular ischemia by OCT angiography

Quantitative Evaluation of Parafoveal Microvasculature Changes in Eyes with Exudative Circumscribed Choroidal Haemangioma : An Optical Coherence Tomography Angiography Study

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