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

Elnahry, Ayman G.; Abdelkader, Ahmed; Habib, Ahmed E; Elnahry, Gehad A.; Raafat, Karim A; Elrakhawy, Khaled

doi:10.2174/1574887115666200519073704

Cited by 11 publications

(7 citation statements)

References 66 publications

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“…28 Other studies have used OCTA to evaluate the effect of intravitreal injections of anti-VEGF agents on the FAZ size and VD measurements in the macula of patients with DME and yielded conflicting results, but these studies did not separately compare changes in responders and nonresponders. 17,20,[30][31][32][33][34] In the current study, we found a significant increase in the FAZ area in eyes that showed a reduction in CMT after three IVB injections, compared with those that did not respond to treatment (Supplementary Table S1). The differential change in vascularity between eyes that showed an early treatment response, versus those that did not, could be a cause or consequence of the different anatomical response of each group, which calls for further study in a larger number of eyes.…”

supporting

confidence: 57%

Optical Coherence Tomography Angiography Biomarkers Predict Anatomical Response to Bevacizumab in Diabetic Macular Edema

Elnahry¹,

Noureldine²,

Abdelkader³

et al. 2022

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To identify biomarkers that may predict an early anatomical response to the treatment of diabetic macular edema (DME) with intravitreal bevacizumab (IVB) by means of optical coherence tomography angiography (OCTA). Methods: This study is a retrospective study of treatment-naïve patients with DME who underwent 6 × 6 mm OCTA imaging of the macula at baseline and after three monthly IVB injections. Thirty-six eyes of 23 patients were included. Eyes that demonstrated evidence of an early anatomical response, consisting of a >10% decrease in central macular thickness (CMT) (n = 18), were compared with those eyes that failed to show such an improvement (n = 18). Results: At baseline, early-response eyes had worse starting best-corrected visual acuity (BCVA, LogMAR 0.84 ± 0.41 versus LogMAR 0.51 ± 0.15, p = 0.004) and a larger CMT (490 ± 135 µm versus 356 ± 33 µm, p = 0.001), but smaller foveal avascular zones (FAZ) (0.309 ± 0.098mm versus 0.413 ± 0.095 mm, p = 0.003) compared with eyes that proved refractory to three monthly injections of IVB. The vascular density (VD) in both the foveal superficial and deep capillary plexuses was significantly greater in eyes that showed an early-treatment response compared with eyes that were non-responders (24.86 ± 6.90% versus 19.98 ± 7.13%, p = 0.045 and 32.30 ± 4.88% versus 26.95 ± 7.25%, p = 0.028, respectively). Early-treatment response to IVB was predicted by starting CMT (r 2 = 0.266, p = 0.001), FAZ size (r 2 = 0.234, p = 0.003), and VD in the superficial parafovea (r 2 = 0.217, p = 0.004) and deep fovea (r 2 = 0.157, p = 0.037). Conclusion: Projection-resolved OCTA may be useful in predicting an early anatomical response of DME to treatment with IVB.

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supporting

confidence: 57%

Optical Coherence Tomography Angiography Biomarkers Predict Anatomical Response to Bevacizumab in Diabetic Macular Edema

Elnahry¹,

Noureldine²,

Abdelkader³

et al. 2022

DMSO

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“…Originally, this evaluation has depended on the use of FA and expert human graders [16][17][18][19][20][21][22], with several studies that later followed that employed ultra widefield FA imaging in order to evaluate the effect of these VEGF inhibitors on the peripheral retinal perfusion of diabetics as well [39,[47][48][49]. These studies, however, did not provide conclusive results regarding the effect of VEGF inhibition on the status of the macular perfusion of diabetic patients [50]. Prospective.…”

Section: Discussionmentioning

confidence: 99%

Optical Coherence Tomography Angiography of Macular Perfusion Changes after Anti-VEGF Therapy for Diabetic Macular Edema: A Systematic Review

Elnahry

2021

Journal of Diabetes Research

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Background. Diabetic macular edema (DME) is a major cause of vision loss in diabetics that is currently mainly treated by antivascular endothelial growth factor (VEGF) agents. The effect of these agents on macular perfusion (MP) is a current concern. Optical coherence tomography angiography (OCTA) is an imaging modality that allows noninvasive high-resolution retinal microvasculature imaging. Several recent studies evaluated the effect of anti-VEGF agents on the MP of DME patients using OCTA. Our aim is to provide a systematic review of these studies. Methods. Multiple databases were searched including PubMed, Ovid Medline, EMBASE, and Google Scholar for relevant studies published between January 2016 and November 2020 which were included in this review. Studies were compared regarding their design, the number of included patients, the machine and scanning protocol used, the inclusion and exclusion criteria, the number of injections given, the type of anti-VEGF agent used, the outcome measures assessed, and the effect of injections on different MP parameters. Results. A total of 16 studies were included. The studies assessed various OCTA parameters that define MP including the foveal avascular zone area and superficial and deep vascular density and yielded conflicting results. Seven studies showed stable or improved MP following treatment, while 7 studies showed worsening MP following treatment, and 2 studies showed inconclusive results. This could have been due to differences in study design, inclusion criteria, type of anti-VEGF agents used, treatment duration, and methods of image analysis and vascular density quantification. All identified studies were noncomparative case series, and 14 of them (87.5%) used the RTVue XR Avanti OCTA machine. Only one study compared OCTA to fluorescein angiography findings. Conclusion. Analysis of MP changes following VEGF inhibition for DME could benefit from a unified scanning protocol and analysis approach that uses similar study designs to eliminate potential sources of bias. This may provide more definitive conclusions regarding the effect of treatment on MP.

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“…In addition, in previous research, anti-VEGF drugs, such as bevacizumab, ranibizumab, aflibercept, and conbercept were effective for DME ( 14 , 29 ). However, there has been controversy about whether the macular perfusion will get better or worse after anti-VEGF treatment ( 15 , 22 – 24 , 30 ). Zhao et al considered that there were no significant changes of macular and papillary VD after either the panretinal photocoagulation or intravitreal conbercept treatment ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

Microvascular Changes After Conbercept Intravitreal Injection of PDR With or Without Center-Involved Diabetic Macular Edema Analyzed by OCTA

et al. 2022

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PurposeTo investigate the intravitreal injection of conbercept as a treatment strategy for proliferative diabetic retinopathy (PDR) with or without center-involved diabetic macular edema (CI-DME) and evaluate its effect on the microvascular changes in the eyes.MethodsIn this prospective study, 43 patients including 29 cases (56 eyes) in CI-DME with PDR patients, and 14 cases (26 eyes) in the non-center involving diabetic macular edema (NCI-DME) with PDR patients were involved in this study. The best corrected visual acuity (BCVA), central retinal thickness (CRT), foveolar avascular zone (FAZ), and macular capillary vessel density (VD) of the superficial retinal capillary plexus (SCP) and deep retinal capillary plexus (DCP) were assessed before and after conbercept treatments for 1, 3, or 6 months.ResultsThe BCVA was significantly increased after conbercept treatment in the eyes of CI-DME patients. After 6 months of treatment with the conbercept, microvascular density of the inferior area in SCP and the central fovea area in DCP increased significantly, regardless of the central fovea involvement. The effect of the conbercept treatment on the VD of NCI-DME was higher than that of CI-DME. Then, after 6 months of treatment, the CRT of patients with CI-DME and NCI-DME were decreased significantly.ConclusionsIn this study, an intravitreal injection of conbercept significantly improved vision, alleviated macular edema in patients with DME. Conbercept treatment also altered the microvascular density in the retina.

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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

Cited by 11 publications

References 66 publications

Optical Coherence Tomography Angiography Biomarkers Predict Anatomical Response to Bevacizumab in Diabetic Macular Edema

Optical Coherence Tomography Angiography Biomarkers Predict Anatomical Response to Bevacizumab in Diabetic Macular Edema

Optical Coherence Tomography Angiography of Macular Perfusion Changes after Anti-VEGF Therapy for Diabetic Macular Edema: A Systematic Review

Microvascular Changes After Conbercept Intravitreal Injection of PDR With or Without Center-Involved Diabetic Macular Edema Analyzed by OCTA

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