Abstract
Purpose :
To evaluate the effects of intravitreal aflibercept injection on retinal nonperfusion in patients with diabetic retinopathy using ultrawide field (UWF) fluorescein angiography (FA).
Methods :
This prospective open label clinical trial included 38 consecutive patients who has diabetic retinopathy with retinal nonperfusion (nonperfusion index (NPI): nonperfused/total gradable area > 0.2). Patients with center involved diabetic macular edema were not enrolled. Monthly injection of 2mg aflibercept was given to the patients for 6 months. Both 200°UWF images, UWF FA images were acquired at the baseline, 6 month and 12 month visit. And The UWF-FA images were evaluated by 2 masked, independent graders for extent of retinal nonperfusion and vascular leakage.
Results :
Distribution of DR severity was as follows: moderate nonproliferative DR (NPDR), 10.5%; severe NPDR, 21.1%; very severe NPDR, 39.5%; early proliferative DR (PDR), 28.9%. There was strong inter-grader (r = 0.81) agreement for NPI measurements. NPI was 0.46 at baseline. After 6 monthly injection of aflibercept, NPI was decreased to 0.43 (P = 0.015), and slightly increased to 0.44 (P = 0.123) at the last visit after another 6 month observation. Improvement of retinal nonperfusion after aflibercept injections was associated with younger age (OR = 0.791, P = 0.026), larger area of baseline nonperfusion (OR = 1.185, P = 0.005). Also, vascular leakage was significantly decreased showing a 21.0% reduction between the baseline and the 6 month visit.
Conclusions :
These data suggest monthly aflibercept treatment might reduce retinal nonperfusion in diabetic retinopathy without significant macular edema.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.