Short-term choroidal vascular changes after aflibercept therapy for neovascular age-related macular degeneration

Pellegrini, Marco; Bernabei, Federico; Mercanti, Andrea; Sebastiani, Stefano; Peiretti, Enrico; Iovino, Claudio; Casini, Giovanni; Loiudice, Pasquale; Scorcia, Vincenzo; Giannaccare, Giuseppe

doi:10.1007/s00417-020-04957-5

Cited by 21 publications

(10 citation statements)

References 37 publications

(53 reference statements)

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“…Temporary changes in the CVI have been detected in eyes undergoing vitreoretinal surgery 24 ; as none of the included eyes had PPV within the previous 3 months, we found no difference in the CVI between vitrectomized and nonvitrectomized eyes. A reduction in both choroidal thickness and CVI 25 has been described in eyes undergoing intravitreal anti-VEGF for age-related macular degeneration. We did not find such a relationship in our cohort of diabetic subjects.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Diabetic Choroidopathy Using Ultra-Widefield Optical Coherence Tomography

Nicolini

Tombolini

Barresi

et al. 2022

Trans. Vis. Sci. Tech.

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Purpose The purpose of this study was to investigate a confocal scanning laser ophthalmoscopy (cSLO) ultra-widefield (UWF) swept-source optical coherence tomography (S-SOCT) in assessment of diabetic choroidopathy and to evaluate the agreement of measurements with a spectral-domain OCT (SD-OCT) instrument. Methods We conducted a cross-sectional study of patients with diabetes evaluating the choroidal vascularity index (CVI) in the nasal, temporal, and central macula segments of a UWF SS-OCT scan centered to the fovea. UWF pseudocolored fundus images were used for diabetic retinopathy (DR) severity staging. The CVI values were compared between different degrees of severity of DR and different posterior-pole sectors with linear mixed models. Central macula CVI measurements were repeated on SD-OCT scans; the interobserver intraclass coefficient (ICC) was calculated between SS-OCT and SD-OCT. Results A total of 151 eyes of 85 patients were included. The CVI values decreased from nonproliferative DR to proliferative DR, with high-risk proliferative DR having significantly lower CVI values than moderate to severe nonproliferative DR ( P = 0.03). The central macula region was the most evidently affected; the nasal sector was the least affected. The agreement between SS-OCT and SD-OCT was moderate (ICC = 0.50). Conclusions Diabetic choroidopathy progresses with worsening of DR toward proliferative disease; choroidal depletion is more prominent in the macula. Caution is recommended in comparing CVI values between different devices. Translational Relevance Choroidal vascularity informs about the severity of DR and its complications, such as macular edema. The agreement between readers and between instruments may be suboptimal in certain cases.

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Section: Discussionmentioning

confidence: 99%

Assessment of Diabetic Choroidopathy Using Ultra-Widefield Optical Coherence Tomography

Nicolini

Tombolini

Barresi

et al. 2022

Trans. Vis. Sci. Tech.

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“…Pellegrini et al [ 15 ] found a significant reduction both in choroidal thickness and in choroidal vascularity index (CVI), calculated as the ratio of luminal area to the total choroidal area, after three monthly aflibercept injections in treatment-naïve nAMD. They proposed that this finding may be a consequence of VEGF suppression which leads to vasoconstriction and to a reduction in the choriocapillaris endothelial cell fenestrations.…”

Section: Discussionmentioning

confidence: 99%

Choroidal Thickness Changes After Intravitreal Aflibercept Injections in Treatment-Naïve Neovascular AMD

et al. 2022

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Introduction Choroidal thickness (CT) plays an important role in the pathogenesis of various ocular diseases, including neovascular age-related macular degeneration (nAMD). Previous studies evaluated the CT variations after anti-vascular endothelial growth factor (VEGF) injections in patients with nAMD, but the results are still controversial. The present study aimed to evaluate the CT at different times (15, 30, 60, 90, and 365 days) after intravitreal aflibercept injections and its correlation with the baseline CT in treatment-naïve patients with nAMD. Secondly, the study evaluated the correlation between CT variation at 365 days and the number of intravitreal injections received. Methods This was a prospective, open-label, single-arm pilot study. Twenty-one treatment-naïve nAMD eyes were enrolled. The study population underwent three monthly aflibercept injections (loading phase) and additional injections as needed (pro re nata regimen). A complete ophthalmological examination, including optical coherence tomography (OCT) was performed at each visit. CT was measured manually by two independent observers. All patients were evaluated at baseline and at 15, 30, 60, 90, and 365 days after the first intravitreal injection. Results CT showed a statistically significant reduction at days 15, 90, and 365 in comparison to baseline. However, the major reduction of CT was observed at day 15 and in eyes with a thicker choroid at baseline. No significant correlation between CT variation and the number of injections performed was found. Conclusion Our findings contribute to clarifying the role of aflibercept injections in choroidal vasculature, confirming its effect after the first 2 weeks. Moreover, CT can be considered as a potential biomarker, as it reflects the pharmacological effect of anti-VEGF drugs.

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“…The loading dose of IVBr caused choroidal thinning with a 16% reduction in the original thickness, which has been reported in at least two studies [ 16 , 19 ]. On the other hand, while the same dosage of IVA can cause choroidal thinning, the extent was similar or lower to that of IVBr [ 20 ]. These results also support the possibility that IVBr strongly affects choroidal lesions.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the regressive effects of aflibercept and brolucizumab on pigment epithelial detachment

et al. 2022

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Background To compare the regressive effects of aflibercept and brolucizumab on pigment epithelial detachment (PED) in age-related macular degeneration. Methods Eighty-three eyes of 83 patients diagnosed with type 1 macular neovascularization were included and retrospectively analysed using multimodal imaging. Forty-nine eyes were treated with intravitreal aflibercept injections (IVA group), and 34 eyes were treated with brolucizumab (IVBr group), with three consecutive injections administered as induction therapy. Before treatment and 1, 2, and 3 months after the first treatment, the maximum height (MH) and maximum diameter (MD) of the PED were measured using optical coherence tomography in each treatment group. Results In the IVA group, MH at baseline (228 ± 169 μm) diminished to 180 ± 150 (P = 0.2558), 165 ± 140 (P = 0.0962), and 150 ± 129 µm (P = 0.0284) at 1, 2, and 3 months after treatment, respectively; the reduction at 3 months was significant. In contrast, in the IVBr group, the MH was 307 ± 254 µm before treatment, and it decreased to 183 ± 156 µm (P = 0.0113), 139 ± 114 µm (P = 0.0003), and 125 ± 126 µm (P < 0.0001) at 1, 2, and 3 months after treatment, respectively, and the reduction at 1 month was significant. In both groups, the MD did not regress significantly. Conclusions The results suggested that the MH of PED after IVBr treatment regressed faster than that after IVA treatment.

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Short-term choroidal vascular changes after aflibercept therapy for neovascular age-related macular degeneration

Cited by 21 publications

References 37 publications

Assessment of Diabetic Choroidopathy Using Ultra-Widefield Optical Coherence Tomography

Assessment of Diabetic Choroidopathy Using Ultra-Widefield Optical Coherence Tomography

Choroidal Thickness Changes After Intravitreal Aflibercept Injections in Treatment-Naïve Neovascular AMD

Comparison of the regressive effects of aflibercept and brolucizumab on pigment epithelial detachment

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