Abstract
Purpose :
To compare the vascular perfusion in peripapillary and macular regions of patients with neovascular age-related macular degeneration (nAMD) with recently started (<5 injections, group 1) and longterm (≥20 injections, group 2) intravitreal anti-VEGF treatment.
Methods :
In this cross-sectional prospective study nAMD patients with either < 5 or ≥20 intravitreal treatments were recruited consecutively. Patients with glaucoma or ocular hypertension at baseline of anti-VEGF treatment and patients with history of retinal vascular disease were excluded. The study evaluated perfusion indices (vessel density, flux index, perfusion density) using Swept-Source Optical Coherence Tomography Angiography in the 6x6mm macular region and in the 2mm width annulus of peripapillary region. Further, Spectral-domain Optical Coherence Tomography analysis of the macular and optic nerve head (ONH) region was performed.
Results :
44 eyes of 44 patients were included in the analysis with a mean number of 2.81 ±1 and 35.8±16 injections in group 1 (n=20) and 2 (n=24), respectively. The groups showed no significant differences regarding mean vessel density (p=0.308), mean blood flux index (p=0.678) and retinal nerve fiber layer thickness (p=0.073) of ONH. In the central 3mm and 6mm macular regions there were no significant differences between the groups regarding superficial (p=0.081, p=0.688) and deep perfusion density (p=0.586, p=0.680), but the superficial temporal/nasal perfusion ratio was significantly lower in long-term treated patients (p=0.03) and there was a non-significant trend towards lower deep temporal/nasal perfusion ratio (p=0.067). Superficial perfusion density in the central 3mm and 6mm macular regions was significantly reduced in eyes with larger lesion at baseline (Pearson r=-0.610; r=-0.467). Eyes with subretinal fluid (n=23, 12 group 1, 11 group 2) showed better superficial macular perfusion density in the central 6mm (p=0.048) compared to eyes without subretinal fluid.
Conclusions :
Long-term intravitreal anti-VEGF treated nAMD eyes did not show different perfusion characteristics or nerve fiber layer thickness of ONH than eyes with recently started anti-VEGF treatment. This might indicate that long-term anti-VEGF treatment is safe regarding ONH alterations. Smaller lesions and presence of subretinal fluid indicated better superficial macular perfusion density.
This is a 2020 ARVO Annual Meeting abstract.