June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Longitudinal Assessment of Retinal Vascular Changes in Eyes with Diabetic Retinopathy Treated with Intravitreal Aflibercept in the PRIME Trial
Author Affiliations & Notes
  • Duriye Damla Sevgi
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Margaret O'Connell
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Charles Clifton Wykoff
    Retina Consultants of Houston, Cleveland, Ohio, United States
  • Hannah Yu
    Retina Consultants of Houston, Cleveland, Ohio, United States
  • Jenna Hach
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Sunil K. Srivastava
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Jamie Reese
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Justis P Ehlers
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Footnotes
    Commercial Relationships   Duriye Damla Sevgi, None; Margaret O'Connell, None; Charles Wykoff, Adverum (F), Alimera Sciences (C), Allegro (C), Allergan (F), Allergan (C), Alynylam (C), Apellis (F), Apellis (C), Bayer (C), Clearside (F), Clearside (C), D.O.R.C. (C), EyePoint (F), EyePoint (C), Genentech/Roch (F), Genentech/Roche (C), Kodiak (C), Neurotech (F), Notal Vision (C), Novartis (F), Opthea (F), Regeneron (F), Regenxbio (F), Samsung (F), Santen (F); Hannah Yu, None; Jenna Hach, None; Sunil K. Srivastava, Abbvie (C), Allergan (F), Allergan (C), Eyepoint (F), Eyepoint (C), Eyevensys (F), Eyevensys (C), Gilead (C), Leica (P), Novartis (C), Regeneron (C), Regeneron (F), Santen (F), Zeiss (C); Jamie Reese, None; Justis Ehlers, Adverum (C), Aerpio (F), Aerpio (C), Alcon (F), Alcon (C), Allegro (C), Allergan (F), Allergan (C), Boehringer-Ingelheim (F), Genentech (F), Genentech/Roche (C), Leica (C), Leica (P), Novartis (F), Novartis (C), Regeneron (F), Regeneron (C), Santen (C), Stealth (C), Thrombogenics/Oxurion (C), Thrombogenics/Oxurion, (F), Zeiss (C)
  • Footnotes
    Support  NIH/NEI K23-EY022947
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1111. doi:
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      Duriye Damla Sevgi, Margaret O'Connell, Charles Clifton Wykoff, Hannah Yu, Jenna Hach, Sunil K. Srivastava, Jamie Reese, Justis P Ehlers; Longitudinal Assessment of Retinal Vascular Changes in Eyes with Diabetic Retinopathy Treated with Intravitreal Aflibercept in the PRIME Trial. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1111.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To evaluate the changes in vascular parameters extracted from Ultra-Widefield Fluorescein Angiography (UWFA) of eyes with diabetic retinopathy that received as needed aflibercept injection (IAI) guided by real-time diabetic retinopathy severity scale (DRSS) or panretinal leakage index (PLI) in the PRIME trial.

Methods : The PRIME prospective trial randomized treatment (1:1) to Group 1 (DRSS-guided) and Group 2 (PLI-guided). The centered early-mid phase UWFA frame that captured the maximum vessel area was selected using an automated software for each visit. Selected frames were aligned using Image J and a common region of interest was determined to ensure the same retinal area was analyzed longitudinally. Retinal vasculature was extracted using a machine learning algorithm. Panretinal vessel area and features of panretinal vascular density (mean, median, variance and skewness) were calculated. Longitudinal changes from baseline to week 52 were assessed using paired t-test. Linear regression models adjusting for age, HbA1c and number of IAI were used to identify the factors correlated with the vascular change.

Results : Twenty-six eyes (Group 1 =12, Group 2 = 14) had data available at week 52. Baseline parameters including age (P=0.812), HbA1c (P=0.343) and vascular features (P >0.05) were not significantly different between the two groups except the skewness of vessel density (P=0.032). Group 1 received a mean of 6.7 (range 5-12) IAI and Group 2 received a mean of 7.2 IAI (range 4-9, P=0.591). The mean panretinal vessel area significantly decreased from 79.7 ± 16.6 mm2 to 74.62 ± 14.3 mm2 (P=0.001). Panretinal mean (P=0.002) and median (P<0.0001) vascular density significantly decreased, and panretinal skewness of vessel density significantly increased (P=0.020). Median vascular density was positively correlated with the change in vessel area (P=0.024).

Conclusions : We demonstrated longitudinal progression of panretinal vascular loss in eyes with diabetic retinopathy treated with as needed aflibercept injections. Improved techniques to investigate vascular remodeling and vascular loss independently may provide more insight to ischemia progression in diabetic retinopathy and the impact of anti-VEGF treatment.

This is a 2021 ARVO Annual Meeting abstract.

 

FA, retinal vasculature and vessel density maps demonstrating the vascular changes from baseline.

FA, retinal vasculature and vessel density maps demonstrating the vascular changes from baseline.

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