OCTA in diabetic macular oedema treated with intravitreal aflibercept (DOCTA Study)
Reviewed by Sofia Rokerya

Central vision loss due to diabetic macular oedema (DME) can be attributed not only to presence of the macular oedema itself but also, in some cases, to alterations of the foveal avascular zone (FAZ). The DOCTA trial was a longitudinal, prospective, non-controlled, single-arm, observational study aimed at conducting a quantitative assessment of macular vessels over time in patients with DME treated with intravitreal aflibercept during a 48-week follow-up using OCTA. Twenty-six eyes having DME from 26 patients were included; mean age, 64.6 years, females, 53.8%. Ten patients received treatment in the right eye only, 10 patients received treatment in the left eye only and six were treated for both eyes. Arterial hypertension (69.2%) and myocardial infarction (19.2%) were the most frequent preexisting comorbidities. Almost half of the patients (46.1%) had previously been treated with an anti-VEGF agent. Diabetic retinopathy was mild in 17 (52.9%) eyes with no scars of pan retinal photocoagulation, moderate in five (29.4%), and severe in three (17.6%). Each eye received a mean (SD) of 7.2 (2.2) injections during the trial period. The parameters of the FAZ did not change during the 48-week follow-up. The mean (SD) area varied from 0.19 (0.19) mm2 at baseline (n = 22) to 0.23 (0.20) mm2 at week 48 (n = 15), from 1.54 (1.21) to 2.04 (1.20) mm for boundary, and from 0.45 (0.33) % to 0.57 (0.20) % for circularity. There was no change in perfusion density and vessel density of the macula in the 3mm circle. As expected, the mean central retinal thickness, macular volume, and visual acuity improved during follow-up. The differentiation between superficial and deep capillary plexus was difficult to demonstrate because the segmentation was often disturbed by artefacts due to the increased thickness of the retina and presence of intraretinal cysts. More randomised controlled trials using OCTA in large populations with extended observation periods are needed to assess changes in macular vessels after intravitreal anti-VEGF treatment. Although OCTA is a useful, non- invasive and repeatable procedure with minimal patient discomfort, it remains to be seen whether this method of visualising the retinal vasculature is likely to become a regular feature of our clinical practice.

Optical coherence tomography angiography in diabetic macular edema treated with intravitreal aflibercept: a 48-week observational study (the DOCTA study).
Korobelnik JF, Gaucher D, Baillife S, et al.
OPHTHALMOLOGICA
2023;246:71–80.