scholarly journals The role of optical coherence tomography angiography biomarkers in assessing the outcome of long-term anti-VEGF therapy of diabetic macular edema

2022 ◽  
Vol 14 (4) ◽  
pp. 95-102
Author(s):  
A. Zh. Fursova ◽  
A. S. Derbeneva ◽  
M. S. Tarasov ◽  
M. V. Vasil’eva ◽  
J. A. Gamza ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Optical Coherence Tomography Angiography ◽  
Antiangiogenic Therapy ◽  
Initial Density ◽  
Average Density ◽  
Vascular Density ◽  
Optical Coherence ◽  
Anti Vegf

The purpose of the study was to assess the changes of biomarkers of diabetic macular edema activity by optical coherence tomography angiography (OCTA) data and the relationship of these biomarkers with the response to anti-VEGF therapy during a two-year follow-up. Material and methods. The study included 59 patients (101) eyes, averagely aged 60.27 ± 9.50 years. The average number of intravitreal injections of aflibercept over the treatment period was 12.87 ± 3.50. The initial size of the foveolar avascular zone (FAZ) area — 0.37 ± 0.22 mm2 , and the acircularity index — 0.56 ± 0.14 remained unchanged after 5 months: 0.36 ± 0.24 mm2  and 0.56 ± 0.12, respectively, and being practically in the same level in 12 and 24 months. The large FAZ area, noted in the group where disorganization of retinal inner layers (DRIL) was observed (0.39 ± 0.21 mm2 ), correlated with a lower visual acuity (r = 0.67, p = 0.003). The acircularity index remained unchanged; no significant differences were found in the DRIL patient groups. After 5 loading injections, the average initial density of vessels in the macular region increased from 12.33 ± 3.86 mm to 12.75 ± 1.14 mm, after 1 year it was 13.48 ± 1.15 mm, after 2 years — 13.25 ± 3.39 mm. The average density of retinal perfusion increased at the 5th month from 29.81 ± 10.85 % to 31.55 ± 2.34 %, after 12 months to 32.91 ± 3.45, and by the end of the observation period to 31.41 ± 9.79 %. In the DRIL group, the baseline vascular density and mean perfusion volume were significantly lower: 11.17 ± 2.09 mm vs. 13.49 ± 1.14 mm and 28.40 ± 4.53 % vs. 31.20 ± 2.44 %). Conclusion. DRIL, a biomarker reflecting impaired capillary blood flow in the superficial capillary plexus and correlating with functional results, can be used as a predictor of antiangiogenic therapy effectiveness. After antiangiogenic therapy with DMO, the microcirculation indices (FAZ and acircularity) remained stable, and the vascular density and perfusion volume tended to increase, which testifies to the absence of ischemic damage.

scholarly journals Optical Coherence Tomography Angiography of Macular Perfusion Changes after Anti-VEGF Therapy for Diabetic Macular Edema: A Systematic Review

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Author(s):  
Ayman G. Elnahry ◽  
Gehad A. Elnahry
Keyword(s):  
Systematic Review ◽  
Optical Coherence Tomography ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Optical Coherence Tomography Angiography ◽  
Vascular Density ◽  
Optical Coherence ◽  
Scanning Protocol ◽  
Anti Vegf ◽  
Retinal Microvasculature

Background. Diabetic macular edema (DME) is a major cause of vision loss in diabetics that is currently mainly treated by antivascular endothelial growth factor (VEGF) agents. The effect of these agents on macular perfusion (MP) is a current concern. Optical coherence tomography angiography (OCTA) is an imaging modality that allows noninvasive high-resolution retinal microvasculature imaging. Several recent studies evaluated the effect of anti-VEGF agents on the MP of DME patients using OCTA. Our aim is to provide a systematic review of these studies. Methods. Multiple databases were searched including PubMed, Ovid Medline, EMBASE, and Google Scholar for relevant studies published between January 2016 and November 2020 which were included in this review. Studies were compared regarding their design, the number of included patients, the machine and scanning protocol used, the inclusion and exclusion criteria, the number of injections given, the type of anti-VEGF agent used, the outcome measures assessed, and the effect of injections on different MP parameters. Results. A total of 16 studies were included. The studies assessed various OCTA parameters that define MP including the foveal avascular zone area and superficial and deep vascular density and yielded conflicting results. Seven studies showed stable or improved MP following treatment, while 7 studies showed worsening MP following treatment, and 2 studies showed inconclusive results. This could have been due to differences in study design, inclusion criteria, type of anti-VEGF agents used, treatment duration, and methods of image analysis and vascular density quantification. All identified studies were noncomparative case series, and 14 of them (87.5%) used the RTVue XR Avanti OCTA machine. Only one study compared OCTA to fluorescein angiography findings. Conclusion. Analysis of MP changes following VEGF inhibition for DME could benefit from a unified scanning protocol and analysis approach that uses similar study designs to eliminate potential sources of bias. This may provide more definitive conclusions regarding the effect of treatment on MP.

scholarly journals Evaluation of Changes in Macular Perfusion Detected by Optical Coherence Tomography Angiography following 3 Intravitreal Monthly Bevacizumab Injections for Diabetic Macular Edema in the IMPACT Study

2020 ◽  
Vol 2020 ◽  
pp. 1-14 ◽  
Author(s):  
Ayman G. Elnahry ◽  
Ahmed A. Abdel-Kader ◽  
Karim A. Raafat ◽  
Khaled Elrakhawy
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Optical Coherence Tomography Angiography ◽  
Intravitreal Bevacizumab ◽  
Vascular Density ◽  
Ophthalmological Examination ◽  
Optical Coherence ◽  
Macular Area ◽  
The Impact

Objective. To evaluate macular perfusion changes following intravitreal bevacizumab injections for diabetic macular edema (DME) using spectral domain optical coherence tomography angiography (SD-OCTA). Methods. This study was a prospective noncomparative interventional case series. Treatment naïve patients with DME underwent full ophthalmological examination and SD-OCTA scanning at baseline and after 3 intravitreal bevacizumab injections. Both the 6 × 6 and 3 × 3 mm macular scan protocols were used. Pretreatment and posttreatment OCTA images were automatically aligned using a commercially available retina alignment software (i2k Align Retina software); then the fractal dimension (FD), vascular density (VD), and skeleton VD changes were obtained at the full retinal thickness (Full) and superficial (SCP) and deep (DCP) capillary plexuses after processing images using a semiautomated program. The foveal avascular zone (FAZ) was manually measured and FD was calculated using the FracLac plugin of ImageJ. Results. Forty eyes of 26 patients were included. Following injections, there were an 8.1% increase in FAZ, 1.3% decrease in FD-Full and FD-SCP, 1.9% decrease in FD-DCP, 8% decrease in VD-Full, 9.1% decrease in VD-SCP, 10.6% decrease in VD-DCP, 13.3% decrease in skeleton VD-Full, 12.5% decrease in skeleton VD-SCP, and 16.3% decrease in skeleton VD-DCP in the 6 × 6 mm macular area and a 2.6% decrease in FD-Full, 3.4% decrease in FD-SCP, 11.5% decrease in VD-Full, 14.3% decrease in VD-SCP, and 25.1% decrease in skeleton VD-SCP in the 3 × 3 mm macular area which were all statistically significant p<0.05. Using univariate and multivariate analysis, the pretreatment FD, VD, and skeleton VD at each capillary layer significantly negatively correlated with the change in FD, VD, and skeleton VD at the corresponding capillary layer, respectively p<0.05. Conclusion. OCTA is a useful noninvasive tool for quantitative evaluation of macular perfusion changes following DME treatment. This trial is registered with NCT03246152.

scholarly journals Evaluation of the Effect of Repeated Intravitreal Bevacizumab Injections on the Macular Microvasculature of a Diabetic Patient Using Optical Coherence Tomography Angiography

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Ayman G. Elnahry ◽  
Ahmed A. Abdel-Kader ◽  
Karim A. Raafat ◽  
Khaled Elrakhawy
Keyword(s):  
Optical Coherence Tomography ◽  
Diabetic Patient ◽  
Macular Edema ◽  
Female Patient ◽  
Diabetic Macular Edema ◽  
Optical Coherence Tomography Angiography ◽  
Intravitreal Bevacizumab ◽  
Vascular Density ◽  
Optical Coherence ◽  
The Right

A 53-year-old female patient with center-involving diabetic macular edema affecting the left eye was imaged using optical coherence tomography angiography (OCTA) in both eyes. She underwent three monthly intravitreal bevacizumab injections in the left eye only and OCTA was repeated in both eyes one month following the last injection and showed decreased vascular density (VD) in the treated left eye but not in the untreated right eye compared to baseline. No further injections were required in either eye, and OCTA was done in both eyes 4 months following the last injection which showed improved VD of the left eye with stable VD in the right. Three monthly intravitreal bevacizumab injections were then required in both eyes; then OCTA was repeated following the last injection and revealed decreased VD in both eyes compared to previous scan. OCTA could be a useful tool for detecting VD changes following bevacizumab injections in diabetics.

scholarly journals Changes in Macular Perfusion Detected by Optical Coherence Tomography Angiography Following 3 Intravitreal Monthly Bevacizumab Injections for Diabetic Macular Edema in the IMPACT Study

2019 ◽  
Author(s):  
Ayman Elnahry ◽  
Ahmed A. Abdel-Kader ◽  
Karim A. Raafat ◽  
Khaled Elrakhawy
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Optical Coherence Tomography Angiography ◽  
Intravitreal Bevacizumab ◽  
Vascular Density ◽  
Ophthalmological Examination ◽  
Optical Coherence ◽  
Macular Area ◽  
The Impact

Abstract Background This study was done to evaluate macular perfusion changes following intravitreal bevacizumab injections for diabetic macular edema (DME) using spectral domain optical coherence tomography angiography (SD-OCTA). Methods This study was a prospective noncomparative interventional case series. Treatment naïve patients with DME were recruited at Cairo University retina clinic and underwent full ophthalmological examination and SD-OCTA scanning at baseline and after 3 intravitreal bevacizumab injections. Both the 6X6 and 3X3-mm macular scan protocols were used. Pre and post-treatment OCTA images were automatically aligned using a commercially available retina alignment software (i2k Align Retina software) then the fractal dimension (FD), vascular density (VD), and skeleton VD changes were obtained at the full retinal thickness (Full) and superficial (SCP) and deep (DCP) capillary plexuses after processing images using a semi-automated program. The foveal avascular zone (FAZ) was manually measured and FD was calculated using the FracLac plugin of ImageJ. Results Forty eyes of 26 patients were included. Following injections, there was an 8.1% increase in FAZ, 1.3% decrease in FD-Full and FD-SCP, 1.9% decrease in FD-DCP, 8% decrease in VD-Full, 9.1% decrease in VD-SCP, 10.6% decrease in VD-DCP, 13.3% decrease in skeleton VD-Full, 12.5% decrease in skeleton VD-SCP, and 16.3% decrease in skeleton VD-DCP in the 6X6 mm macular area, and a 2.6% decrease in FD-Full, 3.4% decrease in FD-SCP, 11.5% decrease in VD-Full, 14.3% decrease in VD-SCP, and 25.1% decrease in skeleton VD-SCP in the 3X3 mm macular area which were all statistically significant (p<0.05). There was also an 8.3% increase in the FAZ, 18.5% decrease in skeleton VD-Full, 2.6% decrease in FD-DCP, 8.8% decrease in VD-DCP, and 19.7% decrease in skeleton VD-DCP in the 3X3 mm macular area but these were not statistically significant (p>0.05). Using univariate and multivariate analysis, the pre-treatment FD, VD, and skeleton VD at each capillary layer significantly negatively correlated with the change in FD, VD, and skeleton VD at the corresponding capillary layer respectively (p>0.05). Conclusion OCTA is a useful non-invasive tool for quantitative evaluation of macular perfusion changes following DME treatment. Trial Registration Trial registered at ClinicalTrials.gov on August 11, 2017 (Study ID: NCT03246152).

scholarly journals Hyperreflective foci on optical coherence tomography associate with treatment outcome for anti-VEGF in patients with diabetic macular edema

PLoS ONE ◽  
2018 ◽  
Vol 13 (10) ◽  
pp. e0206482 ◽  
Author(s):  
Vivian Schreur ◽  
Lebriz Altay ◽  
Freekje van Asten ◽  
Joannes M. M. Groenewoud ◽  
Sascha Fauser ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Treatment Outcome ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Optical Coherence ◽  
Hyperreflective Foci ◽  
Anti Vegf

scholarly journals Stepwise segmentation error correction in optical coherence tomography angiography images of patients with diabetic macular edema

2020 ◽  
Vol 12 ◽  
pp. 251584142094793
Author(s):  
Khalil Ghasemi Falavarjani ◽  
Reza Mirshahi ◽  
Shahriar Ghasemizadeh ◽  
Mahsa Sardarinia
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Optical Coherence Tomography Angiography ◽  
Plexiform Layer ◽  
Vessel Density ◽  
Inner Plexiform Layer ◽  
Optical Coherence ◽  
Density Measurements ◽  
Segmentation Error

Aim: To determine the minimum number of optical coherence tomography B-scan corrections required to provide acceptable vessel density measurements on optical coherence tomography angiography images in eyes with diabetic macular edema. Methods: In this prospective, noninterventional case series, the optical coherence tomography angiography images of eyes with center-involving diabetic macular edema were assessed. Optical coherence tomography angiography imaging was performed using RTVue Avanti spectral-domain optical coherence tomography system with the AngioVue software (V.2017.1.0.151; Optovue, Fremont, CA, USA). Segmentation error was recorded and manually corrected in the inner retinal layers in the central foveal, 100th and 200th optical coherence tomography B-scans. The segmentation error correction was then continued until all optical coherence tomography B-scans in whole en face image were corrected. At each step, the manual correction of each optical coherence tomography B-scan was propagated to whole image. The vessel density and retinal thickness were recorded at baseline and after each optical coherence tomography B-scan correction. Results: A total of 36 eyes of 26 patients were included. To achieve full segmentation error correction in whole en face image, an average of 1.72 ± 1.81 and 5.57 ± 3.87 B-scans was corrected in inner plexiform layer and outer plexiform layer, respectively. The change in the vessel density measurements after complete segmentation error correction was statistically significant after inner plexiform layer correction. However, no statistically significant change in vessel density was found after manual correction of the outer plexiform layer. The vessel density measurements were statistically significantly different after single central foveal B-scan correction of inner plexiform layer compared with the baseline measurements ( p = 0.03); however, it remained unchanged after further segmentation corrections of inner plexiform layer. Conclusion: Multiple optical coherence tomography B-scans should be manually corrected to address segmentation error in whole images of en face optical coherence tomography angiography in eyes with diabetic macular edema. Correction of central foveal B-scan provides the most significant change in vessel density measurements in eyes with diabetic macular edema.

scholarly journals Vitreoretinal interface abnormalities in diabetic macular edema and effectiveness of anti-VEGF therapy: an optical coherence tomography study

2017 ◽  
Vol Volume 11 ◽  
pp. 1995-2002 ◽  
Author(s):  
Alexei Kulikov ◽  
Sergei Sosnovskii ◽  
Roman Berezin ◽  
Dmitrii Maltsev ◽  
Dzhambulat Oskanov ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Optical Coherence ◽  
Vitreoretinal Interface ◽  
Anti Vegf
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