Choriocapillaris changes on OCT Angiography after Anti-VEGF injections in Exudative Age Related Macular Degeneration

Abstract

Purpose : To describe changes in the choriocapillaris seen on optical coherence tomography angiography (OCT-A) after treatment with intravitreal anti-VEGF in the setting of active neovascular age related macular degeneration (nAMD).

Methods : Review of medical records from a multi-practitioner retina group revealed 15 eyes (14 patients) with active nAMD. NAMD was diagnosed with OCT and/or fluorescein angiography. All 14 patients underwent OCT-A before and 4-6 weeks after receiving anti-vegf therapy. An independent observer recorded changes in the choriocapillaris structure seen on OCT-A.

Results : Ten eyes received treatment with bevacizumab, 5 eyes received treatment with aflibercept. Fourteen patients were anti-vegf treatment naïve, 1 patient had received 1 injection 5 months prior. Of the 15 eyes, 8 had neovascularization of the choroidal vessels. Varying degrees of regression of these abnormal vessels was seen in all 8 cases after anti-VEGF injection (Figure 1). Two eyes had pigment epithelial detachments (PED) centrally which blocked the underlying choriocapillaris. In these 2 patients, the PED decreased in size after receiving anti-vegf therapy. Fourteen patients showed initial drop-out of the normal choriocapillaris. The choriocapillaris drop-out improved in all cases after receiving anti-VEGF injection. One patient had normal choriocapillaris structure pre and post-injection.

Conclusions : OCT-A is becoming an increasingly useful tool to non-invasively image the choroidal microvasculature. This case series demonstrates that the choriocapillaris undergoes changes after treatment with anti-vegf injection. The anti-vegf therapy appears to normalize the choriocapillaris structure and decrease choriocapillaris drop-out. The return to physiologic blood flow and perfusion likely leads to decrease in the intra-retinal and sub-retinal fluid seen in nAMD. Understanding this technology further may allow for better prediction of when exudative disease has been controlled.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Figure 1: Changes in choriocapillaris. A. Pre-injection choriocapillaris angioflow: Patient has abnormal choriocapillaris structure B. Pre-injection choriocapillaris enface C. Pre-injection B scan: Sub-retinal fluid present D. Post-injection choriocapillaris angioflow: The choriocapillaris has normalized E. Post-injection choriocapillaris enface F. Post-injection B scan: Resolution of sub-retinal fluid