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Reinhard Told, Gregor Sebastian Reiter, Ferdinand Georg Schlanitz, Lorenz Wassermann, Tamara Jasmin Mittermüller, Eleonore Pablik, Guenther Weigert, Stefan Sacu, Andreas Pollreisz, Ursula Schmidt-Erfurth; Prognostic OCTA Factors on Visual Acuity after Loading Phase in Patients with neovascular AMD. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3478. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the longitudinal influence of OCTA parameters on the visual function in patients with nAMD after a three months loading dose with aflibercept.
50 eyes of 50 patients with treatment-naïve nAMD were included in this ongoing observational study. Patients were closely followed during the first 3 months. Aflibercept was administered at baseline (BL), day 30 and 60. OCTA was acquired at BL, day 1, 3, 7, 14, 30, 37, 44, 60, 67, 74, 90. 6x6 mm OCTA (Zeiss, PlexElite) images were acquired and 25 OCTA characteristics analyzed (CNV: area, vessel area, vessel %-area, fractal dimension (FD), number of junctions, junctions density, total vessel length, average vessel length, total number of endpoints, mean lacunarity; FAZ: area, circularity, perimeter; Superficial and Deep Retinal Plexus: FD, FD ETDRS ring 1 and 2, skeletonized (s) FD, sFD ETDRS 1 and 2;) using Image J and AngioTool. A baseline corrected mixed model was used to determine the short-term effect of Afilbercept on OCTA parameters and the prognostic effect on visual function was calculated.
From the parameters investigated, CNV area and CNV vessel area were prognostic for visual outcome, where smaller baseline lesion and vessel area indicate better visual function after a three month loading dose. All of the investigated CNV characteristics show a significant change (all p<0.05) seven days after Aflibercept injection, except for FD, %vessel area, average vessel length and lacunarity. Further, a significant effect on FAZ area and perimeter as well as on FD of the inner ETDRS ring in the superficial and deep retinal plexus was detected. The model also showed that all CNV characteristics follow the same response pattern; the higher the BL value the stronger the response to Aflibercept. This was not the case in the superficial and deep retinal plexus.
In conclusion this study shows a pathognomonic response of the neovascular complex and an effect on the superficial and deep retinal complex following anti-VEGF treatment. This indicates that aflibercept not only affects neovascular vessels, but also the retinal vasculature. Further, OCTA derived CNV area and CNV vessel area are prognostic factors determining visual function in patients with neovascular AMD. These resuts support the use of OCTA characteristics in larger clinical trials.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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