Macular capillary plexuses during anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration

Abstract

Purpose : To investigate macular vascular alterations using optical coherence tomography angiography (OCTA) in patients who had undergone long-term treatment with anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (nAMD).

Methods : Japanese patients with nAMD who had undergone long-term anti-VEGF monotherapy at study entry were studied retrospectively. Macular vascular alterations were measured on en-face OCT images in a 6 x 6-mm macular region obtained using spectrum-domain OCT. Vessel densities (mm^-1) of the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC), and the summated plexus foveal avascular zone (FAZ) area (mm²), calculated using the AngioExcerciser V1.2.2 (Carl Zeiss Meditec, Dublin, CA), were compared between the first and last OCTA images during the study.

Results : One hundred sixteen eyes of 85 patients were included: 57 (49%) eyes had typical AMD and 59 (51%) eyes had polypoidal choroidal vasculopathy (PCV). The mean ± standard deviation follow-up period between the first and last OCTA examinations was 11.7 ± 3.7 months, and the duration of anti-VEGF monotherapy before the first OCTA was 61.9 ± 24.9 months. The treatment schedules were pro ne rata injections in 80 (69%) eyes, treat-and-extend regimen in 15 (13%) eyes, and fixed injections in 21 (18%) eyes. The vessel densities in the DCP and CC decreased significantly from 10.12 ± 2.85 mm^-1 and 11.52 ± 2.09 mm^-1 to 9.45 ± 2.89 mm^-1 and 11.11 ± 2.13 mm^-1 (P=0.002 and P=0.027, respectively). No apparent differences were seen in the FAZ and SCP between the first (0.23 ± 0.21 mm² and 14.52 ± 0.56 mm^-1) and last (0.25 ± 0.24 mm² and 14.43 ± 0.65 mm^-1) examinations. While no correlations were found between the changes in the vessel densities of the CC and number of intravitreal injections of anti-VEGF agents or treatment schedules, the decrease in the vessel density in the CC in eyes with typical AMD (0.71 ± 1.87 mm^-1) was significantly (P=0.017) greater than in eyes with PCV (0.11 ± 1.98 mm^-1).

Conclusions : OCTA quantifies structural changes in the macular capillary plexuses during anti-VEGF treatment in eyes with nAMD. The DCP and choriocapillaris deteriorate during treatment based on the AMD subtype.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.