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This retrospective consecutive case series examined 54 eyes of 54 treatment-naïve neovascular age-related macular degeneration (N-AMD) patients. Thirty-three eyes received intravitreal aflibercept injections, and 21 eyes received intravitreal ranibizumab injections with unaffected fellow eyes (54 eyes) as controls. All image scans were acquired after the macular architecture had recovered after treatment. Using swept-source OCT and OCTA (DRI OCT-1, Atlantis; Topcon Corporation, Tokyo, Japan), two independent graders manually outlined the inner border of foveal capillaries with OCT-A software, which then automatically calculates the foveal avascular zone (FAZ) area. This OCTA software also produced a map that consisted of concentric circles with diameters of 1 and 3mm and provided an automated vessel density (VD) analysis in the superficial capillary plexus (SCP). Both the superficial and deep FAZ areas were significantly larger in the aflibercept group (SCP: 0.490 ±0.117, deep retinal capillary plexus (DCP): 1.060 ±0.255mm2) vs. control group (SCP: 0.380 ±0.118, DCP: 0.791 ±0.220mm2). The mean FAZ areas for both the SCP and DCP in the ranibizumab group (SCP: 0.432 ±0.165, DCP: 0.989 ±0.458mm2) were smaller than in the aflibercept group and larger than in the control group, the differences were not statistically significant. The VD was also significantly reduced in the aflibercept group, with (mean: 39.38 ±1.94, centre: 13.62 ±3.62%) and ranibizumab group (mean: 39.50 ±2.50, centre: 16.76 ±5.27%) than in the control group (mean: 41.18 ±1.98, centre: 17.94 ±4.21%). The authors conclude that prolonged and repeated anti-VEGF therapy may lead to an increase in the FAZ area and a decrease in the VD in patients with N-AMD, indicating ischaemic damage.

Changes in the foveal avascular zone area and retinal vessel density after anti-VEGF therapy for neovascular age-related macular degeneration.
Park YS, Moon H, Woo JM, Min JK.
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Su Young

Moorfields Eye Hospital NHS Trust, London, UK.

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