Short-term choroidal vascular changes after aflibercept therapy for neovascular age-related macular degeneration
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Short-term choroidal vascular changes after aflibercept therapy for neovascular age-related macular degeneration Marco Pellegrini 1 & Federico Bernabei 1 & Andrea Mercanti 2 & Stefano Sebastiani 2 & Enrico Peiretti 3 & Claudio Iovino 4 & Giamberto Casini 5 & Pasquale Loiudice 5 & Vincenzo Scorcia 6 & Giuseppe Giannaccare 1,6 Received: 18 May 2020 / Revised: 11 August 2020 / Accepted: 1 October 2020 # The Author(s) 2020
Abstract Introduction The purpose of this study was to evaluate choroidal vascular changes in patients with neovascular age-related macular degeneration (nAMD) treated with aflibercept injection over a 3-month period. Methods Enhanced depth imaging optical coherence tomography scans of 60 eyes with treatment-naïve nAMD and 60 unaffected fellow eyes were retrospectively analyzed. Data was collected at baseline and after 3 monthly intravitreal injections of aflibercept. The ImageJ software was used to binarize OCT scans and measure total choroid area (TCA), luminal area (LA), and stromal area (SA). Choroidal vascularity index (CVI) was defined as the ratio of LA to TCA. Results After treatment, subfoveal choroidal thickness (CT) in nAMD eyes significantly decreased from 210. 6 ± 61.6 to 194.6 ± 58.7 μm (P < 0.001), TCA from 1.620 ± 0.502 to 1.500 ± 0.451 mm2 (P < 0.001), LA from 1.075 ± 0.335 to 0.985 ± 0.307 mm2 (P < 0.001), SA from 0.545 ± 0.176 to 0.516 ± 0.153 mm2 (P = 0.005), and CVI from 66.36 ± 2.89 to 65.46 ± 2.87% (P = 0.009). The decrease of CVI after treatment was significantly correlated with baseline CVI (Rs = 0.466, P < 0.001), but not with the change in BCVA and presence of dry macula after treatment (always P > 0.05). Conclusion Choroidal thickness and vascularity significantly decreased after treatment with aflibercept in nAMD eyes. Besides the pharmacologic effect on the neovascular lesion, aflibercept may induce vascular changes also on the underlying choroid. Keywords Age-related macular degeneration . Anti-VEGF . Choroidal vascularity index . Optical coherence tomography
Key messages Anti-vascular endothelial growth factor agents represent the first line treatment for neovascular age macular degeneration, however, there is no definite consensus on the changes in choroidal circulation occurring in these eyes after therapy. Vascularity significantly decreased after treatment with Aflibercept in eyes with neovascular age macular degeneration. Besides the pharmacologic effect on the neovascular lesion, Aflibercept may induce vascular changes also on the underlying choroid.
* Marco Pellegrini [email protected] 1
Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Via Palagi 9, 40138 Bologna, Italy
2
Ophthalmology Unit, Head and Neck Department of Ophthalmology, Infermi Hospital, Rimini, Italy
3
Department of Surgical Science, Eye Clinic, University of Cagliari, Cagliari, Italy
4
Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, N
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