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

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

Abstract

Introduction: The purpose of this study was to evaluate choroidal vascular changes in patients with neovascular age-related macular degeneration (nAMD) treated with aflibercept injection over a 3-month period.

Methods: Enhanced depth imaging optical coherence tomography scans of 60 eyes with treatment-naïve nAMD and 60 unaffected fellow eyes were retrospectively analyzed. Data was collected at baseline and after 3 monthly intravitreal injections of aflibercept. The ImageJ software was used to binarize OCT scans and measure total choroid area (TCA), luminal area (LA), and stromal area (SA). Choroidal vascularity index (CVI) was defined as the ratio of LA to TCA.

Results: After treatment, subfoveal choroidal thickness (CT) in nAMD eyes significantly decreased from 210. 6 ± 61.6 to 194.6 ± 58.7 μm (P < 0.001), TCA from 1.620 ± 0.502 to 1.500 ± 0.451 mm2 (P < 0.001), LA from 1.075 ± 0.335 to 0.985 ± 0.307 mm2 (P < 0.001), SA from 0.545 ± 0.176 to 0.516 ± 0.153 mm2 (P = 0.005), and CVI from 66.36 ± 2.89 to 65.46 ± 2.87% (P = 0.009). The decrease of CVI after treatment was significantly correlated with baseline CVI (Rs = 0.466, P < 0.001), but not with the change in BCVA and presence of dry macula after treatment (always P > 0.05).

Conclusion: Choroidal thickness and vascularity significantly decreased after treatment with aflibercept in nAMD eyes. Besides the pharmacologic effect on the neovascular lesion, aflibercept may induce vascular changes also on the underlying choroid.

Keywords: Age-related macular degeneration; Anti-VEGF; Choroidal vascularity index; Optical coherence tomography.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Choroidal vascularity index calculation with binarization of spectral-domain OCT images. a Choroidal boundaries are traced to identify the total choroidal area (red lines). b The image is binarized with Niblack’s auto-local threshold. c The color threshold tool is used to select the dark pixels, representing the luminal area (yellow lines). The choroidal vascularity index is computed dividing luminal area by total choroidal area
Fig. 2
Fig. 2
Enhanced depth imaging OCT with calculation of choroidal vascularity index in a representative eye with neovascular age-related macular degeneration at baseline (a) and after 3 monthly intravitreal injections of aflibercept (b)
Fig. 3
Fig. 3
Scatterplots showing the relationship between age and subfoveal choroidal thickness (a), total choroidal area (b), and choroidal vascularity index (c) in eyes with neovascular age-related macular degeneration at baseline. Age was significantly correlated with subfoveal choroidal thickness and total choroidal area but not with choroidal vascularity index
Fig. 4
Fig. 4
Scatterplots showing the relationship between choroidal vascularity index at baseline and intraocular pressure (a) and decrease of choroidal vascularity index after 3 monthly intravitreal injections of aflibercept (b) in eyes with neovascular age-related macular degeneration

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