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Ariana Levin, Irene Rusu, Anton Orlin, Mrinali Gupta, Donald J D'Amico, Szilard Kiss; Reversal of peripheral ischemia following Anti-VEGF treatment for diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):No Pagination Specified. doi: https://doi.org/.
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High blood glucose levels damage the retinal vasculature and cause retinal ischemia, resulting in elevated levels of VEGF protein that exacerbates the damage. Major clinical trials have demonstrated that anti-VEGF therapies improve vision and normalize vessels within the field of 7SF fluorescein angiography. However, ischemic areas outside the field of 7SF FA are also clinically significant. Our study aimed to quantitatively demonstrate reperfusion of ischemic areas of the retina on ultra-widefield fluorescein angiography (UWFA) in patients treated with anti-VEGF intravitral injections for diabetic retinopathy.
In a retrospective case series, we analyzed UWFA images of 17 eyes of 16 patients, who received anti-VEGF intravitreal injections and pre- and post-injection UWFA. Each image was analyzed both qualitatively (by two graders) and quantitatively (using ImageJ software) for an increase in perfusion in ischemic areas following anti-VEGF treatment. In ImageJ, images were binarized so that perfused areas appeared white. Increased perfusion was measured as an increase in white pixel number.
Twelve of 17 eyes (70.6%) or 11 of 16 patients (68.8%) demonstrated reperfusion following anti-VEGF injection. On UWFA, reperfusion was detected both within the field of 7SF FA and in the periphery.
In patients with diabetic retinopathy, ischemic areas of the peripheral retina have the potential to reperfuse following anti-VEGF intravitral injections. Areas reperfuse both within the field of 7SF FA and in the periphery. Further studies will be needed to elucidate the association between treatment regimens and the potential for reperfusion.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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