Hemodynamic Effects of Anti-Vascular Endothelial Growth Factor Injections on Optical Coherence Tomography Angiography in Diabetic Macular Edema Eyes

Jessica Song, Bonnie B. Huang, Janice X. Ong, Nicholas Konopek, Amani A. Fawzi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Purpose: To evaluate retinal hemodynamic responses to anti-vascular endothelial growth factor (VEGF) injection in eyes with diabetic macular edema using optical coherence tomography angiography (OCTA). We performed a comparison of two different thresholding methods to identify the most accurate for studying the vessel density (VD) in diabetic macular edema eyes. Methods: The study prospectively included 26 eyes of 22 subjects (aged 60.2 ± 13.7 years) who underwent OCTA scan before and after anti-VEGF injection (mean inter-val between OCTA = 31.1 ± 17.3 days). We analyzed adjusted flow index, VD, and Skeletonized vessel length density in the parafoveal area (3-mm annulus with a 1-mm inner circle), along with full-thickness fovea avascular zone area and central foveal thickness (CFT). Using averaged scans VD as the ground truth, we compared two different algorithms for VD at the different plexuses. Longitudinal changes were assessed using a generalized linear model correcting for central foveal thickness and Q-score. Results: We found significantly decreased adjusted flow index in the DCP layer (P = 0.010) at the follow-up. Furthermore, foveal avascular zone (P < 0.001) and central foveal thickness (P = 0.003) showed significant decrease on follow-up compared with baseline. Comparing the thresholding algorithms showed that vessel length density– based thresholding was more accurate for quantifying the DCP VD. Conclusions: The adjusted flow index decreased significantly in the DCP layer on follow-up OCTA scan, suggesting vascular flow disruption and decreased deep retinal perfusion after anti-VEGF injection. Our results also highlight the fact that the choice of threshold-ing method is particularly critical for DCP quantification in eyes with diabetic macular edema. Translational Relevance: Findings confirmed impaired deep retinal capillary flow after anti-VEGF injection.

Original languageEnglish (US)
Article number5
JournalTranslational Vision Science and Technology
Volume11
Issue number10
DOIs
StatePublished - Oct 2022

Keywords

  • OCTA
  • anti-VEGF injection
  • diabetic macular edema

ASJC Scopus subject areas

  • Ophthalmology
  • Biomedical Engineering

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