Foveal capillary perfusion density decreases in diabetics with DME treated on a fixed regimen of intravitreal aflibercept injections over 24 months

Abstract

Purpose : To evaluate changes in capillary perfusion density (CPD) in patients with diabetic macular edema (DME) undergoing fixed intravitreal aflibercept injections (IAI) through 24 months in the SWAPTWO study

Methods : SWAPTWO is a prospective, interventional, single arm study enrolling 20 patients with persistent DME despite prior treatment with bevacizumab or ranibizumab. All patients received IAI every 4 weeks until DME resolution and were then extended to fixed q8week dosing for the duration of the study. OCTA (Optovue Inc, California, USA) was obtained at baseline, 6-months, 12-months, and 24-months. Superficial and deep CPD changes from baseline were measured, and correlations between final visual acuity (VA) and fovea-only, parafoveal and foveal+parafoveal (“whole”) CPD were analyzed at 24 months

Results : Sixteen of the 20 eyes completed the study through 24 months. The mean number of IAI received per eye during study duration was 15.2. The average CST at baseline was 420 ± 34 and improved to 251 ± 38 (p<0.001) at 24 months. VA improved from baseline at both 12- and 24-months but was only statistically significant at 24-months (+5.5 letters; p=0.042). At 24-months, whole superficial CPD decreased by 5.3% ± 3.1 from baseline (p=0.001); deep CPD decreased by 4.4% ± 3.3 (p=0.009). Better final VA was positively correlated with less CPD loss within the superficial parafovea [r= +0.66 (0.23,0.88); p=0.006) and whole [r= +0.60 (0.12, 0.85); p=0.017] areas. There was no statistical significance correlation between final VA and the following: mean superficial fovea-only CPD values and deep foveal, parafoveal and whole CPD values

Conclusions : Despite fixed q8week dosing with IAI after DME resolution through 24 months, both superficial and deep CPD measurements decreased, suggesting that perfusion continues to be affected despite fixed anti-VEGF dosing. Better final VA was correlated with less CPD loss within the superficial parafovea and “whole” (fovea+parafovea) areas

This is a 2020 ARVO Annual Meeting abstract.