Changes in Retinal Microvasculature and Visual Acuity After Antivascular Endothelial Growth Factor Therapy in Retinal Vein Occlusion

Abstract

PURPOSE. To investigate the changes in the retinal microvasculature during the course of anti-VEGF therapy in eyes with macular edema due to retinal vein occlusion (RVO) and their association with visual outcomes.METHODS. The vessel density (VD) and foveal avascular zone (FAZ) area in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were quantitatively measured by optical coherence tomography angiography (OCTA) in 48 consecutive eyes with RVO before and 1, 3, 6, 9, and 12 months after anti-VEGF therapy. Anti-VEGF therapy was performed either with ranibizumab or aflibercept following a pro re nata (PRN) regimen. The correlation between post-treatment best-corrected visual acuity (BCVA) and changes in the retinal microvasculature evaluated by OCTA were assessed.RESULTS. The BCVA improved significantly at 12 months (P < 0.001). Better BCVA at 12 months was significantly associated with a better VD in the SCP and DCP both at baseline (R 2 ¼ 0.524, P < 0.001 and R 2 ¼ 0.457, P < 0.001, respectively) and at 12 months (R 2 ¼ 0.521, P < 0.001 and R 2 ¼ 0.662, P < 0.001, respectively). Overall, both VD and FAZ did not change significantly during the 12 months. However, the progression of nonperfusion was observed in the SCP in 6 (13%) eyes and in the DCP in 10 (21%) eyes. The number of macular edema recurrence was significantly associated with a decrease in the VD (P ¼ 0.006 [SCP] and P < 0.001 [DCP]) and less visual gain (P ¼ 0.02) after treatment.CONCLUSIONS. Anti-VEGF therapy maintains retinal perfusion in most patients with RVO. Preserving retinal perfusion is crucial for better visual outcomes.

Higher aqueous levels of matrix metalloproteinases indicated visual impairment in patients with retina vein occlusion after anti-VEGF therapy

“…In this study, MMP-1 and MMP-2 were positively correlated with macular superficial capillary density. Winegarner et al reported a positive correlation between better BCVA and superficial capillary density in RVO patients (27); whereas we observed a negative correlation between MMP1 and visual improvement. In our study, the aqueous humor level of MMP1, superficial capillary density and visual improvement do not support each other.…”

Five-year outcomes of retinal vein occlusion treated with vascular endothelial growth factor inhibitors

“…Progression of ischaemia is a significant cause of permanent vision loss in eyes with RVO 46. In this study, progression of capillary nonperfusion was observed in six (8.8%) eyes despite use of anti-VEGF over the 5 years of follow-up.…”

Papillary Vessel Density Changes after Intravitreal Anti-VEGF Injections in Hypertensive Patients with Central Retinal Vein Occlusion: An Angio-OCT Study

“…Recent studies [34,35] focused on vessel density changes and macular perfusion in RVO after anti-VEGF using OCTA technology. Andrew Winegarner et al [34] found no significant changes in mean VD 12 months after anti-VEGF injections in patients with RVO, although higher VD and a smaller FAZ were associated with better BCVA. Other authors [24,35,36] confirmed no significant variation of macular VD after treatment.…”

“…We mentioned above that it is possible to hypothesize that masking effect or retinal vessel displacement due to edema could justify the reappearance of the vessels that were poorly identified before treatment [32,33,34,35].…”