Peripapillary and macular microvasculature in neovascular age-related macular degeneration in long-term versus recently started anti-vascular endothelial growth factor therapy and healthy controls

Author: Laura Hoffmann* (Switzerland)

Co-authors: Cengiz Türksever*, Katja Hatz

Purpose

To investigate alterations in the peripapillary and macular microvasculature in eyes with neovascular age-related macular degeneration (nAMD) in recently started versus long-term anti-vascular endothelial growth factor (VEGF) therapy compared to healthy controls using swept-source optical coherence tomography angiography–based (OCTA) microangiography (OMAGc).

Setting/Venue

Non-interventional prospective single-visit study.

Methods

All eyes were recruited at Vista Eye Clinic, Switzerland, between 2019 and 2021. Eyes with nAMD receiving intravitreal anti-VEGF injections using a treat-and-extend regimen (TER) were assigned to group 1 (less than 5 injections) or 2 (≥ 20 injections) whereas group 3 constituted the healthy age-matched controls. Blood ﬂow signals were acquired using OMAGc algorithm of PLEX® Elite 9000 Swept-Source OCTA (Carl Zeiss Meditec, Inc., Dublin, USA) in 6x6mm scans centered on the fovea and the optic nerve head (ONH). Spectral-domain OCT (Spectralis OCT; Heidelberg Engineering, Heidelberg, Germany) scans were obtained of the macular and ONH region. Quality of the OCTA scans, intraocular pressure (IOP) following the intravitreal injection and hemodynamic parameters were assessed. Comparisons between subgroups were calculated using ANOVA analysis.

Results

A total of 80 eyes whereof 40 eyes in the control group were included. Macular superficial perfusion density in the central 3 and 6mm was significantly reduced in group 1 and 2 compared to controls (p= 0.001; p=0.010) without a significant difference between groups 1 and 2. The presence of subretinal fluid was associated with a better superficial macular perfusion density in the central 6mm (p=0.036). Mean peripapillary flux index was significantly lower in group 2 than in controls (p=0.023) in the absence of a significant correlation with neither IOP elevation after the injection nor the number of anti-VEGF injections received. An increased pulse pressure was observed in group 2 in comparison to groups 1 and 3 (p=0.003; p=0.012).

Conlusions

Reduced perfusion density of the inner retina might be related to a local vasoconstrictor effect of anti-VEGF treatment. Increased pulse pressure in long-term treated subjects may be linked to systemic side-effects of the treatment. Neither repeated injections nor postoperative IOP elevations were correlated to an altered peripapillary microvasculature.