Abstract
Purpose :
We examined blood flow changes before and after 12-month treatment with intravitreal aflibercept injection (IVA) or intravitreal brolucizumab injection (IVBr) for untreated neovascular age-related macular degeneration (nAMD).
Methods :
Our study included 14 eyes of 14 cases with untreated nAMD (10 males, 4 females, mean age 72.1±6.2 years) who visited Kagawa University between October 2020 and May 2022; patients were randomly assigned to 6 IVA groups and 8 IVBr groups by a random number table. Anti-vascular endothelial growth factor (VEGF) drugs were administered every month for the first three doses and thereafter as needed. The blood flow around the optic nerve head (ONH) and the choroidal blood flow in the macular region were measured before and after treatment. Laser speckle flowgraphy (LSFG) was used to measure Mean Blur Rate (MBR), which reflects blood flow velocity, to evaluate blood flow. The MBR of the large vessels in the ONH region and the choroidal MBR of the macular region were measured before and at 1, 3, 6, and 12 months after initiation of anti-VEGF drug treatment, and changes in blood flow were compared prospectively.
Results :
At the initial visit, logMAR best corrected visual acuity (BCVA) was 0.22±0.14, central retinal thickness (CRT) 428.9±159.3 µm, ONH MBR 35.5±8.8, and macular choroidal MBR 7.8±2.0. The number of doses administered up to 12 months was 4.2 ± 1.2 for all patients, 5.2 ± 1.7 for the IVA group, and 3.9 ± 0.8 for the IVBr group. At 12 months after treatment, logMAR BCVA and CRT improved significantly (p<0.001, p<0.001) and macular choroidal MBR decreased (p=0.002), but ONH MBR did not change significantly (p=0.122). There were no significant differences in logMAR BCVA, ONH MBR, or macular choroidal MBR in the IVA group (p=0.090, p=0.229, p=0.882), but CRT improved significantly (p=0.001). LogMAR BCVA and CRT improved in the IVBr group (p<0.001, p=0.002) and macular choroidal MBR was decreased (p=0.002), but ONH MBR did not change significantly (p=0.558). Macular choroidal MBR at the initial visit was significantly negatively correlated with logMAR BCVA 12 months after treatment and with logMAR BCVA change at 12 months (p=0.033, p=0.017).
Conclusions :
Our results suggest that macular choroidal blood flow may be affected by IVBr.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.