Long-Term Anti-VEGF Injections May Affect Macular Vessel Density in AMD

Long-term anti-VEGF treatment for patients with AMD reduces the vascular density of the SPF retinal plexus to a greater extent compared to the deep retinal plexus.

Patients who receive anti-vascular endothelial growth factor (VEGF) injections have reduced macular vessel density in the foveal area of the superficial (SPF) retinal plexus, a cross-sectional study published in BMC Ophthalmology shows.

Patients (n=42) with age-related macular degeneration (AMD) and healthy controls (n=18; mean age, 73.33 years; 8 women, 10 men; best-corrected visual acuity [BCVA] 82.28 ETDRS) were recruited at Semmelweis University in Hungary. All participants underwent optical coherence tomography angiography (OCT-A) assessments and ophthalmic features were compared between controls and patients with AMD on the basis of anti-VEGF treatment duration. Among the AMD cohort, 17 received 20 or more anti-VEGF injections (mean, 20.29 injections; mean age, 71.12 years; 12 men, 5 women; BCVA 63.60 ETDRS) and 25 received less than 1 year of treatment (mean, 6.84 injections; mean age, 74.84 years; 10 men, 15 women; BCVA 66.00 ETDRS).

Using OCT-A, the researchers observed patients with AMD (compared with those in the control group) had significantly lower macular vessel density in the SPF parafovea, SPF whole, deeper fovea areas and greater density in nonflow areas and the foveal avascular zone (all P ≤.05). In addition, the short-term anti-VEGF recipients had reduced vessel density in the SPF fovea (P <.01) and long-term anti-VEGF recipients had greater central retinal thickness (P <.01) compared with controls.

Among the AMD cohorts, the patients who had received fewer injections had significantly lower macular vessel density in the SPF fovea (mean, 16.82% vs 25.36%; P <.05) and parafovea (mean, 41.16% vs 45.06%; P <.05) compared with those who received more injections, respectively.

It seems that the reduction of choriocapillary and retinal blood flow are parallel phenomena with AMD.

“There is growing knowledge on how anti-VEGF therapy affects choroidal neovascularisations in patients with neovascular AMD, but there is much less information on how anti-VEGF therapy affects retinal circulation,” the researchers report. “It seems that the reduction of choriocapillary and retinal blood flow are parallel phenomena with AMD.”

The results of this study may not be generalizable for patients with AMD who have poor BCVA, as the patients included in this study had relatively good visual acuity.

References:

Resch MD, Balogh A, Kurth T, Nagy ZZ, DeBuc DC, Papp A. Atrophy of retinal vessels in neovascular age‑related macular degeneration following long‑term treatment with 20 intravitreal anti‑VEGF injections. BMC Ophthalmol. 2022;22(1):469. doi:10.1186/s12886-022-02700-8