The Difference of Changes in Ocular Blood Flow after Intravitreal Injection for Diabetic Macular Edema between Aflibercept and Faricimab

Abstract

Purpose : The difference of changes in ocular blood flow between intravitreal aflibercept (IVA) and intravitreal faricimab (IVF) is not well understood. We performed a retrospective, observational clinical study to evaluate and compare the effects of each treatment on the blood flow of retinal vessels of the peripapillary region and of the optic nerve head (ONH) of eyes with diabetic macular edema (DME) assessed using laser speckle flowgraphy (LSFG).

Methods : Eighteen eyes of 16 patients treated with IVA and 11 eyes of 8 patients treated with IVF for DME were included. Mean blur rate (MBR) of the ONH and of a retinal artery and vein of the peripapillary region were measured using LSFG at baseline and 1 month after injection. Also, central retinal thickness (CRT) were measured in all cases. To evaluate the relative changes in the MBR, we used dMBR expressed as a rate of change from the baseline values; dMBR was defined as follows: dMBR(%) = 100 – (MBR before injection / MBR after injection × 100).

Results : CRT decreased significantly in IVA (p = 0.0003) and IVF (p = 0.0034). Some of the MBR related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV) and MBR of tissue area (MT) decreased significantly at 1 month after IVA and IVF compared to baseline values (MA of IVA, p = 0.0071; MT of IVA, p = 0.0292; MA of IVF, p = 0.002). MBR of the retinal artery (MBR-A) and vein (MBR-V) decreased significantly at 1 month after IVA compared to baseline values (MBR-A of IVA, p = 0.0166; MBR-V of IVA, p = 0.0397) but no significant difference was seen after IVF. There was no significant difference in dMA, dMV, dMT, dMBR-A and dMBR-V between IVA and IVF.

Conclusions : Intravitreal injection led to a reduction of ocular blood flow both in the retinal peripapillary vessels and in the ONH in IVA and a reduction of ocular blood flow in the ONH in IVF. No significant difference was observed in MBR reduction between IVA and IVF. Reduction of ocular blood flow is associated with peripapillary vessel constriction and decrease of peripapillary blood ocular flow may be related to reduction of CRT.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Median (1st quartile – 3rd quartile) computed for each parameters at baseline and 1 month after injection.
* p < 0.05 Wilcoxon signed rank test

 

Comparisons of the changes in the MBR in IVA and IVF.
* p < 0.05 Mann-Whitney U test