Abstract
Purpose :
Optical Coherence Tomography Angiography (OCT-A) is a relatively new imaging modality with the ability to assess retinal and choroidal vasculature without the use of intravenous contrast agents. Studies have shown that OCT-A is equal to, and in some areas superior to FA in visualizing microvasculature changes in diabetic retinopathy. Patients frequently show improvement in visual acuity (VA) one week after anti-VEGF injection for DME, independent of change in macular edema. Studies have identified changes in retinal vasculature as seen on OCT-A in patients with DME, usually one month or more after injection. However, current knowledge is lacking on the OCT-A findings in DME after anti-VEGF injection in the acute setting, particularly one week after injection. The purpose of our study is to better evaluate the short-term effects of anti-VEGF in DME, with specific focus on the retinal microvasculature seen on OCT-A.
Methods :
Retrospective chart review was conducted for adult patients at Kresge Eye Institute. Patients were included if they were diagnosed with CSDME treated with anti-VEGF injection, and if they had OCT/OCT-A imaging the day of their injection as well as within 9 days after injection. The primary outcome was to compare the changes in vascular morphology and signal strength as seen on OCT-A of the macula before and after injection.
Results :
One eye of 11 patients were included in our study, with OCT-A performed before and after injection for a total of 22 imaging results. There was an observable increase in the density of the spider vortex architecture of the deep capillary plexus after injection. Qualitative image quality increased between the images obtained before and after injection. There was a trend toward increased signal strength and improved VA one week after injection, however the sample size was too small to reach clinical significance.
Conclusions :
There are observable changes in retinal vascular density in the acute setting after anti-VEGF injection for DME, specifically in the spider web vortex architecture of the deep capillary plexus. There is a trend for improved VA and enhanced imaging signal strength after injection. There was not a significant decrease in macular edema on OCT one week after injection to explain the improved VA. Changes in retinal vasculature and increased media clarity are potential mechanisms for VA improvement independent of change in macular edema.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.