Topographical Analysis of the Choriocapillaris Reperfusion After Loading Anti-VEGF Therapy in Neovascular AMD

Abstract

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.

Vessel density on optical coherence tomography angiography is prognostic for future disease course in intermediate uveitis

“…Choriocapillaris non-perfused area (CCNPA) was analyzed using the Phansalkar method (with a radius of 5 pixels) as previously described 21 . Projection artifacts from superficial retinal vessels 22 were removed for analysis of deep retinal and choriocapillary layers using the proprietary algorithm provided by the OCT-A device (Zeiss PLEX Elite 9000, Carl Zeiss Meditec, Dublin, California, USA). The analysis in this study was focused on VD as retinal OCT-A outcome measure, since this is the most basic and relevant OCT-A parameter.…”

Evidence for Genetic Causal Relationships Between Multiple Immune-Mediated Inflammatory Diseases and Age-Related Macular Degeneration: A Univariable and Multivariable Mendelian Randomization Study

“…Despite concerted efforts to mitigate the progression of this AMD variant, it remains recalcitrant to current therapeutic interventions. Conversely, wet AMD is characterized by choroidal neovascularization, the proliferation of aberrant blood vessels from the choroid penetrating the retina, culminating in retinal edema [ 7 ]. This phenotype can be treated with pharmaceuticals derived from nucleic acids, monoclonal antibodies, or chimeric proteins, such as anti-vascular endothelial growth factor drugs [ 7 ], which are expected to promote reperfusion of choroidal capillaries and improve the patient’s condition.…”

“…Conversely, wet AMD is characterized by choroidal neovascularization, the proliferation of aberrant blood vessels from the choroid penetrating the retina, culminating in retinal edema [ 7 ]. This phenotype can be treated with pharmaceuticals derived from nucleic acids, monoclonal antibodies, or chimeric proteins, such as anti-vascular endothelial growth factor drugs [ 7 ], which are expected to promote reperfusion of choroidal capillaries and improve the patient’s condition. Hence, early detection of this severe, age-related disorder is imperative for substantially improving the quality of life in the aging demographic.…”

Effects of diabetic retinopathy on longitudinal morphological changes in AMD-associated type 1 macular neovascularization

“…specially for neovascular AMD (nAMD)), other studies did not find any correlation between these two disorders 5 , while others found diabetes as a protective factor 6 . Importantly, diabetic retinopathy (DR) and nAMD share treatment options, as anti-VEGF intravitreal injections are used to treat both AMD-associated macular neovascularization (MNV) and diabetic macular oedema 7 , 8 .…”

“…With the recent advent of optical coherence tomography angiography (OCTA), an accurate assessment of the retinal and choroidal layers at a high resolution has been allowed in vivo 9 , 10 . Importantly, OCTA has provided the ability to assess anatomic characteristics of MNV and its longitudinal changes in response to anti-VEGF treatment in patients with neovascular AMD 7 , 11 . The latter studies have demonstrated an overall reduction in MNV size after anti-VEGF therapy 7 , 12 , 13 .…”