Retrospective analysis of the effect of aflibercept loading dose on the retinal vessel diameters in patients with treatment-naive neovascular AMD

Purpose: To investigate the short-time effect of intravitreal injections (IVI) of the vascular endothelial growth factor inhibitors ranibizumab and aflibercept on retinal arterial and venous oxygen saturation (SO2a and SO2v), arteriovenous oxygen saturation difference (AVD) and vessel diameter (VDa and VDv) in patients with diabetic macular oedema (DME) and patients with choroidal neovascularization (CNV) due to age-related macular degeneration. Methods: Uncontrolled prospective observational study in 100 eyes. Retinal vessel oxygen saturation and diameters were assessed using a retinal oximeter before and minutes after IVI of ranibizumab or aflibercept. Results: 40 eyes with CNV and 34 eyes with DME were included in the analysis. At baseline, SO2a and SO2v were significantly higher in DME (p = 0.043 and p = 0.009, respectively). After IVI, SO2a significantly decreased in CNV and DME eyes by 2.6% (p = 0.016) and 4.6% (p = 0.002) and SO2v decreased by 14.0% (p = 0.004) and 12.4% (p = 0.017), respectively. However, a significant increase in AVD was only found in CNV (15.7%, p = 0.001). VDa decreased significantly only in DME by 5.7% (p = 0.010). No medication-specific disease effect was found and vice versa. Conclusions: The observed changes can be interpreted as signs of increased metabolic demand during the physiological stress after an IVI. The abnormal arterial constriction and the abolished increase in AVD seen only in eyes with DME indicate an impairment of vascular autoregulation and oxygen distribution and a reduced neuroretinal metabolism in the diabetic retina with a significant impact on inner retinal oxygen consumption shortly after IVI.

Section: Discussionmentioning

confidence: 99%

Short‐time effect of intravitreal injections on retinal vascular oxygenation and vessel diameter in patients with diabetic macular oedema or neovascular age‐related macular degeneration

Mitsch

Pemp

Pollreisz

et al. 2019

“…; Tetikoglu et al. ). We speculate that the vasoconstriction of retinal vessels demonstrated in this study following intravitreal injection of aflibercept is probably in truth a mere reversal of the vasodilative effect of VEGF.…”

Section: Discussionmentioning

confidence: 98%

Alterations in retinal arteriolar microvascular structure associate with higher treatment burden in patients with diabetic macular oedema: results from a 12‐month prospective clinical trial

Blindbæk

Grauslund

2019

Purpose: This study was based on data from a 12-month prospective clinical trial and aimed to examine changes in retinal microvascular structure in eyes treated with intravitreal aflibercept in combination with focal/grid laser photocoagulation for diabetic macular oedema (DME). Methods: We included 32 treatment na€ ıve eyes of 22 patients with centre involving DME. The treatment algorithm comprised a loading phase of three monthly injections of aflibercept and focal/grid laser photocoagulation [baseline (BL)-month 3 (M3)] followed by a pro re nata (PRN) aflibercept phase until month 12 (M12). Eyes were divided into groups with and without need for PRN treatment after loading. Parameters of retinal microvascular structure were measured in 45°optic disc centred fundus images at BL, M3 and M12 using a semi-automated software (VAMPIREâ, Vessel Assessment and Measurement Platform for Images of the Retina, Universities of Dundee and Edinburgh, UK). Results: A significant decrease in retinal arteriolar calibre was demonstrated at both M3 (À11.2 lm, p = 0.005) and M12 (À11.5 lm, p = 0.04) as compared to BL in eyes that needed PRN treatment during follow-up. In contrast, arteriolar calibre remained unchanged in eyes without need for PRN treatment (M3: À1.6 lm, p = 0.79 and M12: À7.0 lm, p = 0.22). For retinal venules, vessel calibre decreased both in eyes with and without need for PRN therapy at M3 (À9.5 lm, p = 0.01 and À11.6 lm, p = 0.01) as well as at M12 (À15.6 lm, p = 0.001 and À11.0 lm, p = 0.04). Conclusion: Early changes in retinal arteriolar calibre are associated with an increased treatment burden during the first year of DME treatment.

“…Lately, another paper reported significant vasoconstriction of the retinal arterioles after three monthly injections of aflibercept using a computer‐based approach (Tetikoğlu et al. ).…”

Section: Discussionmentioning

confidence: 99%

“…However, choroidal thickness has lately been shown to decline in patients with AMD following three injections of aflibercept (Tetikoğlu et al. ). As expected, we observed transient rise in IOP, but no correlation with the amount of reflux was shown.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Short‐term effect on the ocular circulation induced by unilateral intravitreal injection of aflibercept in age‐related maculopathy

Mursch‐Edlmayr

Luft

Podkowinski

et al. 2019

Purpose Intravitreal injection of anti‐vascular endothelial growth factor (anti‐VEGF) is the standard treatment for neovascular age‐related macular degeneration (AMD). As VEGF is a physiological key player for regulating retinal vascular tone, questions have been raised whether the application of anti‐VEGF could induce alterations in ocular perfusion. Methods The study included 20 eyes from 20 Caucasian patients with unilateral neovascular AMD and 20 fellow eyes. All eyes were treated with standard intravitreal injection of aflibercept (IVA). Measurements of blood flow at the optic nerve head (ONH) and the choroid were performed with laser speckle flowgraphy (LSFG). The intraocular pressure (IOP), systolic and diastolic blood pressure, heart rate, mean arterial pressure (MAP) and ocular perfusion pressure (OPP) were analysed. Measurements were performed at baseline and repeated immediately after the injection and 30 and 45 min later. Results Mean time between injection of aflibercept and first follow‐up was 8:56 ± 4:25 min. The injection led to significant rise in IOP. In the injected eyes, mean blur rate (MBR, i.e. a relative measure of perfusion and the main outcome parameter of LSFG) within the major vessels of the ONH as well as at the entire ONH region decreased significantly (p < 0.001). No change in MBR was observed in the fellow eye. Choroidal blood flow was maintained stable in both eyes. Conclusion Intravitreal injection of aflibercept (IVA) led to a short‐term reduction in perfusion only in the treated eye. This was independent from IOP, indicating a direct pharmacological effect. No changes in choroidal perfusion were observed during the first 45 min after the injection.