Widerfield Swept Source Optical Coherence Tomography Angiography Metrics as Predictors of Anti-VEGF Treatment in Retinal Vein Occlusion

Abstract

Purpose : The primary objective of this study is to assess the role of baseline widerfield swept-source OCTA (WF SS-OCTA) vascular metrics in predicting the number of anti-VEGF injections required and final visual acuity in eyes with retinal vein occlusion (RVO).

Methods : Prospective longitudinal study including RVO eyes that were treatment-naïve or did not receive anti-VEGF injections for at least 3 months prior to imaging. 6x6-mm and 12x12-mm angiograms were captured with WF SS-OCTA (PLEX® Elite 9000, Carl Zeiss Meditec). Vascular metrics including foveal avascular zone (FAZ) metrics, vessel density (VD), and vessel skeletonized density (VSD) were calculated on the ARI network (Zeiss Portal v5.4-1206). Multiple linear regression models were employed to explore the predictors for 1) the number of anti-VEGF injections required; and 2) visual acuity outcome, with duration from diagnosis to imaging and age being used as adjustment variables, respectively.

Results : We included 49 RVO eyes from 49 patients with a mean age of 59.3 ± 14.9 years. Our regression analysis revealed that multiple VD and VSD metrics on 6x6 and 12x12-mm scans were significantly associated with the number of anti-VEGF injections required at 3, 6, and 12 months after WF SS-OCTA imaging, as well as VA at 12 months after WF SS-OCTA imaging in all RVO eyes and RVO eyes with a history of receiving an anti-VEGF injection. However, these predictors were not significant in the treatment-naïve group. Specifically, a reduction in the VD of the superficial capillary plexus (SCP) on 6x6-mm scans was significantly associated with a greater number of anti-VEGF injections at 3, 6, and 12 months (β*= -0.54, p=0.004; β*= -0.60, p=0.002; β*= -0.48, p=0.006). Additionally, reductions in the VD SCP and whole retina (WR) on 12x12-mm scans was associated with worse VA at 12 months (β*= -0.46, p=0.005, β*= -0.47, p=0.004).

Conclusions : Our study demonstrates the association between WF SS-OCTA vascular metrics and the number of anti-VEGF injections needed at 3, 6, and 12 months post-WF SS-OCTA imaging. These findings support the utility of WF SS-OCTA in the clinical assessment, management, and prognosis of patients with RVO.

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