Review on Recent Trials Evaluating the Effect of Intravitreal Injections of Anti-VEGF Agents on the Macular Perfusion of Diabetic Patients with Diabetic Macular Edema

Ayman G Elnahry, Ahmed A Abdel-Kader, Ahmed E Habib, Gehad A Elnahry, Karim A Raafat, Khaled Elrakhawy, Ayman G Elnahry, Ahmed A Abdel-Kader, Ahmed E Habib, Gehad A Elnahry, Karim A Raafat, Khaled Elrakhawy

Abstract

Background: Diabetic macular edema (DME) is a major cause of vision loss in diabetics worldwide. Anti-vascular endothelial growth factor (anti-VEGF) agents have become the mainstay of treatment of vision loss due to DME. Long-term effects of these agents on the macular perfusion (MP) are a current concern.

Objective: To review recently published studies that evaluated the effect of intravitreal injection of anti-VEGF agents on the MP of diabetics with DME.

Methods: Different databases were searched including PubMed, Medline, Ovid, Science Direct, and Google Scholar for relevant studies published between 2010 and 2019. All studies found were compared regarding methodology and results and included in this review. Some studies relating to retinal perfusion in general and not strictly MP were also included for comprehensiveness.

Results: Several studies utilizing different anti-VEGF agents were identified. All the large randomized controlled clinical trials identified utilized primarily fluorescein angiography (FA) and human graders and found generally no worsening of MP associated with anti-VEGF agents use in diabetic patients with DME. Some of these studies, however, depended on post-hoc analysis. Several more recent, but smaller case series, have utilized the relatively new and non-invasive optical coherence tomography angiography (OCTA) in this evaluation and found more conflicting results.

Conclusion: The large clinical trials recently performed depended mainly on FA in the analysis of MP changes following injections and generally found no worsening of MP. More recently, smaller case series have utilized OCTA in this analysis, yielding more conflicting results. Large randomized controlled trials using OCTA are thus needed.

Keywords: Anti-VEGF agents; clinical trials; diabetic macular edema; fluorescein angiography; macular perfusion; optical coherence tomography angiography.

Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.

Figures

Fig. (1)
Fig. (1)
FA and OCTA images of a patient from our research group are shown. Fluorescein angiography imaging uses an intravenously injected fluorescent dye which is detected inside retinal vessels by a blue light that is absorbed by the fluorescent dye and is re-emitted as another light of longer wavelength allowing visualization of the retinal vasculature and areas of capillary loss on a background of diffuse choroidal fluorescence (A and B). OCTA is a non-invasive, dye-free imaging modality that can obtain images of the superficial (C) and deep (D) retinal vascular layers separately by comparing the decorrelation signal between consecutive, repeated OCT B-scans that are acquired in rapid succession at the same retinal location, allowing motion contrast generated by the flow of red blood cells in blood vessels to be detected leading to vascular imaging.

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