Effect of Intravitreous Anti–Vascular Endothelial Growth Factor Therapy on Choroidal Thickness in Neovascular Age-Related Macular Degeneration Using Spectral-Domain Optical Coherence Tomography

Abstract

A critical method of monitoring patients with neovascular age-related macular degeneration (AMD) being treated with anti-vascular endothelial growth factor (anti-VEGF) is optical coherence tomography (OCT), which uses low-coherence interferometry of light to examine the retina in vivo on a micrometer scale. 1 Recent advances in spectral-domain OCT make visualization of the choroid feasible. Using image averaging and enhanced depth imaging, successful examination and measurement of choroidal thickness in normal and pathologic states have been reported. [2][3][4] It has been hypothesized that anti-VEGF may affect choroidal vasculature. 5 The goal of this study is to evaluate the effect of anti-VEGF on choroidal thickness using spectral-domain OCT in treatment-naive subjects. MethodsTwenty-two patients (22 eyes) with neovascular AMD were identified prior to first-time treatment with anti-VEGF at New England Eye Center. All patients with concomitant ocular pathologies were excluded. Twenty age-matched healthy eyes were identified as a control group. This study was approved by the institutional review board of the Tufts Medical Center.Patients were imaged with spectral-domain OCT prior to first-time treatment with anti-VEGF therapy and again at 3, 6, and 12 months (Figure 1). Control eyes were imaged at the time of identification and 6 months later. The scan pattern used was Cirrus high-definition 1line raster (Carl Zeiss Meditec), which is a 6-mm line consisting of 4096 A-scans and 20 Bscans averaged together without tracking.

Relationship of Central Choroidal Thickness With Age-Related Macular Degeneration Status

“…[10][11][12][13][14] Neovascular AMD has also been linked with choroidal thinning in some reports, 10,15 although the effect may be related to anti-VEGF therapy. [16][17][18][19] Conclusions drawn from many of these studies are limited by the significant variability of choroidal thickness with age, 20 refractive error, 21 axial length, 22,23 and diurnal cycle, 24,25 which are not often adjusted for in these studies. Moreover, the diagnosis of neovascular AMD may overlap with similar conditions, including polypoidal choroidal vasculopathy and central serous chorioretinopathy, which are associated with a thickened choroid.…”

Effect of intravitreal anti-VEGF on choroidal thickness in patients with diabetic macular edema using spectral domain OCT

“…Anti-VEGF treatment has demonstrated utility in improving visual and anatomical outcomes in DME (4)(5)(6)(7)(8)(9)(10) . The effects of anti-VEGF therapy on choroidal thickness in various diseases, including AMD and DM, have been reported in several previous studies (18,19) . Yiu et al demonstrated that central choroidal thickness decreases following anti-VEGF therapy for DME after 6 months (19) .…”

“…Results of clinical studies have indicated that choroidal thickness may be related to DR severity, and the presence of DME is associated with a significant decrease in choroidal thickness (16) . In patients with neovascular age-related macular degeneration (AMD), anti-VEGF drugs have been shown to induce significant thinning in choroidal thickness, which may lead to unknown long-term consequences or complications (18) . Currently, intravitreal anti-VEGF injections are the most common treatment for DME.…”

“…Currently, intravitreal anti-VEGF injections are the most common treatment for DME. Though anti-VEGF injections improved visual acuity, several studies demonstrated an association with decreased central retinal thickness (18,19) . However, there is currently a lack of studies investigating the effect of anti-VEGF injections on the choroid in patients with diabetes.…”

Evaluation of ocular pulse amplitude and choroidal thickness in diabetic macular edema

“…24,25 Studies have demonstrated that VEGF secreted by RPE cells has a trophic role on the choroidal vasculature. 26 Therefore, blocking the action of VEGF on the choroid with anti-VEGF therapy, the permeability of the choroidal vasculature decreases, which can be noted by a decrease in CT. Lains et al 3 demonstrated a significant decrease in CT in DME patients following treatment with anti-VEGF therapy.…”