{"title":"The Effects of Anti-Vascular Endothelial Growth Factor Loading Injections on Retinal Microvasculature in Diabetic Macular Edema.","authors":"Kiyoung Kim, Junwoo Lee, Seung-Young Yu","doi":"10.1167/tvst.13.12.37","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate changes in the retinal microvasculature using widefield swept-source optical coherence tomography angiography (SS-OCTA) following three anti-vascular endothelial growth factor (anti-VEGF) loading injections for diabetic macular edema (DME).</p><p><strong>Methods: </strong>Thirty-four treatment-naïve patients with DME received an initial three loading injections, followed by injections on an as-needed basis. Macular ischemia was evaluated based on the foveal avascular zone (FAZ) area, perfusion density, and vessel density on a 3 × 3-mm SS-OCTA image. Midperipheral ischemia was analyzed by dividing a 12 × 12-mm image into 16 boxes to compare changes in the nonperfusion area (NPA). Participants were categorized as aggravated, stable, or improved based on changes in the NPA after three injections.</p><p><strong>Results: </strong>Of the 34 included patients, eight (23.5%) demonstrated aggravation of the NPA, 23 (67.6%) remained stable, and three (8.8%) exhibited improvement. Although FAZ area, perfusion, and vessel density increased, the differences were not significant compared to baseline. The number of injections and glycated hemoglobin (HbA1c) levels in the NPA aggravation group were significantly higher than in the stable and improvement groups. Logistic regression analysis revealed that NPA aggravation was independently associated with the number of anti-VEGF injections.</p><p><strong>Conclusions: </strong>Changes in NPA following anti-VEGF loading injections varied among patients with DME and were significantly associated with HbA1c levels and injection frequency. Worsening mid-peripheral NPA after the anti-VEGF injections independently risked DME recurrence.</p><p><strong>Translational relevance: </strong>We revealed that worsening mid-peripheral retinal ischemia after anti-VEGF loading injections contributes to the recurrence of DME.</p>","PeriodicalId":23322,"journal":{"name":"Translational Vision Science & Technology","volume":"13 12","pages":"37"},"PeriodicalIF":2.6000,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684488/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Translational Vision Science & Technology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1167/tvst.13.12.37","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: To evaluate changes in the retinal microvasculature using widefield swept-source optical coherence tomography angiography (SS-OCTA) following three anti-vascular endothelial growth factor (anti-VEGF) loading injections for diabetic macular edema (DME).
Methods: Thirty-four treatment-naïve patients with DME received an initial three loading injections, followed by injections on an as-needed basis. Macular ischemia was evaluated based on the foveal avascular zone (FAZ) area, perfusion density, and vessel density on a 3 × 3-mm SS-OCTA image. Midperipheral ischemia was analyzed by dividing a 12 × 12-mm image into 16 boxes to compare changes in the nonperfusion area (NPA). Participants were categorized as aggravated, stable, or improved based on changes in the NPA after three injections.
Results: Of the 34 included patients, eight (23.5%) demonstrated aggravation of the NPA, 23 (67.6%) remained stable, and three (8.8%) exhibited improvement. Although FAZ area, perfusion, and vessel density increased, the differences were not significant compared to baseline. The number of injections and glycated hemoglobin (HbA1c) levels in the NPA aggravation group were significantly higher than in the stable and improvement groups. Logistic regression analysis revealed that NPA aggravation was independently associated with the number of anti-VEGF injections.
Conclusions: Changes in NPA following anti-VEGF loading injections varied among patients with DME and were significantly associated with HbA1c levels and injection frequency. Worsening mid-peripheral NPA after the anti-VEGF injections independently risked DME recurrence.
Translational relevance: We revealed that worsening mid-peripheral retinal ischemia after anti-VEGF loading injections contributes to the recurrence of DME.
期刊介绍：
Translational Vision Science & Technology (TVST), an official journal of the Association for Research in Vision and Ophthalmology (ARVO), an international organization whose purpose is to advance research worldwide into understanding the visual system and preventing, treating and curing its disorders, is an online, open access, peer-reviewed journal emphasizing multidisciplinary research that bridges the gap between basic research and clinical care. A highly qualified and diverse group of Associate Editors and Editorial Board Members is led by Editor-in-Chief Marco Zarbin, MD, PhD, FARVO.
The journal covers a broad spectrum of work, including but not limited to:
Applications of stem cell technology for regenerative medicine,
Development of new animal models of human diseases,
Tissue bioengineering,
Chemical engineering to improve virus-based gene delivery,
Nanotechnology for drug delivery,
Design and synthesis of artificial extracellular matrices,
Development of a true microsurgical operating environment,
Refining data analysis algorithms to improve in vivo imaging technology,
Results of Phase 1 clinical trials,
Reverse translational ("bedside to bench") research.
TVST seeks manuscripts from scientists and clinicians with diverse backgrounds ranging from basic chemistry to ophthalmic surgery that will advance or change the way we understand and/or treat vision-threatening diseases. TVST encourages the use of color, multimedia, hyperlinks, program code and other digital enhancements.
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