AMD patients on long-term anti-VEGF therapy may experience reduced vascular density.

AMD patients on long-term anti-VEGF therapy may experience reduced vascular density. Photo: Heidelberg. Click image to enlarge. 

A recent study demonstrated that macular vessel density is lower in the foveal area of the superficial retinal plexus in AMD patients after one year and long-term anti-VEGF treatment. These vascular density changes were absent in the parafoveal and whole areas of the deep retinal plexus.

In this cross-sectional study, OCT-A was performed on 60 eyes of 60 patients. The first group of participants consisted of AMD patients receiving long-term (minimum of 20 injections) aflibercept therapy (n=17), and the second consisted of patients treated for one year with a treat-and-extend protocol (n=25). The vascular density values obtained with OCT-A were compared with an age-matched control group of 18 healthy eyes. The team examined the central retinal thickness and the vascular density of the fovea and parafovea in the superficial and deep retinal plexus, as well as evaluated the extent of the non-flow area and the foveal avascular zone (FAZ) on a 3x3mm macular region. Kruskal-Wallis testing was performed for statistical analysis.

In the first group, the vascular density of the superficial retinal plexus of the fovea and parafovea was significantly lower compared with the second group and controls. In the deep retinal plexus, vascular density in the fovea was significantly lower in both AMD groups compared with the control group, with no difference in the parafoveal region. The extent of non-flow area and FAZ was significantly larger in both AMD groups compared with the control group. There was a significant difference in central retinal thickness between those treated for one year and control eyes.

“Our results indicate that long-term anti-VEGF treatment reduces the vascular density of the superficial retinal plexus to a greater extent compared with the deep retinal plexus,” the study authors wrote in their paper.

Resch MD, Balogh A, Kurth T, et al. Atrophy of retinal vessels in neovascular age-related macular degeneration following long-term treatment with 20 intravitreal anti-VEGF injections. BMC Ophthalmol. 2022;22:469.