Volume 29, Issue 4 (Avicenna Journal of Clinical Medicine-Winter 2023)                   Avicenna J Clin Med 2023, 29(4): 188-196 | Back to browse issues page

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Maleki A, Khani Ali Akbari K, Sargolzaie N. Evaluation of the Vascular Density, the Area of Foveal Avascular Zone, and Corrected Vision in Patients with Diabetic Macular Edema after Anti-VEGF Therapy. Avicenna J Clin Med 2023; 29 (4) :188-196
URL: http://sjh.umsha.ac.ir/article-1-2572-en.html
1- Department of Ophthalmology, School of Medicine, Al-Zahra Eye Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
2- Department of Ophthalmology, School of Medicine, Al-Zahra Eye Hospital, Zahedan University of Medical Sciences, Zahedan, Iran , kayhan.khani@gmail.com
3- Department of Social Medicine, School of Medicine, Clinical Immunology Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
Abstract:   (1396 Views)
Background and Objective: This study aimed to evaluate the changes in macular superficial and deep capillary plexus (SCP and DCP) density, Foveal Avascular Zone (FAZ) area, and visual acuity in patients with diabetic macular edema after anti-VEGF therapy.
Materials and Methods: This descriptive-analytical study utilized before and after treatment design. In total, 30 eyes of 30 patients with diabetic macular edema were investigated in this study. Optical Coherence Tomography Angiography (OCTA) images were taken at baseline (before injections) and at visits after injections (30 days after injections). The patients were treated with intravitreal injection of Avastin (Bevacizumab) with a dose of 2.5 mg per month. Macular vessel density of the SCP and DCP, as well as FAZ area were measured in each OCTA. Best corrected visual acuity (BCVA) was measured at baseline visit and at last visit (30 days after the third injection).
Results: The mean age of patients was 57.33 years. Vessel density in SCP, DCP, and FAZ area were found to be significantly different before and after one, two, or three intravitreal injections (P<0.001). However, vessel density was not found to be significantly different in SCP, DCP, and FAZ area among one, two, or three intravitreal injections (P>0.05). Moreover, BCVA was not significantly different before and after intravitreal injections (P>0.05).
Conclusion: In this study, macular vessel density and FAZ area statistically changed following the intravitreal injections of Bevacizumab; however, they were unchanged among three injections. In addition, the BCVA remained unchanged before and after treatment. Anti-VEGF effect on macular perfusion may cause a direct change in the micro vascular flow.
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Type of Study: Original | Subject: Ophthalmology (all specialties)

1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-53. PMID: 15111519 DOI: 10.2337/diacare.27.5.1047
2. Lau LH, Lew J, Borschmann K, Thijs V, Ekinci EI. Prevalence of diabetes and its effects on stroke outcomes: A meta‐analysis and literature review. J Diabetes Investig. 2019;10(3):780-92. PMID: 30220102 DOI: 10.1111/jdi.12932
3. Bhavsar AR, Atebara NH, Drouilhet JH. Retinopathy, diabetic, proliferative. eMedicine Web site. 2009. Available from: https://emedicine.medscape.com/article/1225122-overview
4. Paulus YM, Gariano RF. Diabetic retinopathy: a growing concern in an aging population. Geriatrics. 2009;64(2):16-20. PMID: 19256582
5. Yau JWY, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556-64. PMID: 22301125 DOI: 10.2337/dc11-1909
6. Klein R, Knudtson MD, Lee KE, Gangnon R, Klein BEK. The Wisconsin Epidemiologic Study of Diabetic Retinopathy XXII: the twenty-five-year progression of retinopathy in persons with type 1 diabetes. Ophthal-mology. 2008;115(11):1859-68. PMID: 19068374 DOI: 10.1016/j.ophtha.2008.08.023
7. Zhang X, Zeng H, Bao S, Wang N, Gillies MC. Diabetic macular edema: new concepts in patho-physiology and treatment. Cell Biosci. 2014;4(1):27. PMID: 24955234 DOI:10.1186/2045-3701-4-27
8. . White NH, Sun W, Cleary PA, Tamborlane WV, Danis RP, Hainsworth DP, et al. Effect of prior intensive therapy in type 1 diabetes on 10-year progression of retinopathy in the DCCT/EDIC: comparison of adults and adolescents. Diabetes. 2010;59(5):1244-53. PMID: 20150283 DOI: 10.2337/db09-1216
9. Lee J, Moon BG, Cho AR, Yoon YH. Optical coherence tomography angiography of DME and its association with anti-VEGF treatment response. Ophthalmology. 2016;123(11):2368-75. PMID: 27613201 DOI: 10.1016/j. ophtha.2016.07.010
10. Chew EY, Klein ML, Ferris FL, Remaley NA, Murphy RP, Chantry K, et al. Association of elevated serum lipid levels with retinal hard exudate in diabetic retinopathy: Early Treatment Diabetic Retinopathy Study (ETDRS) Report 22. Arch Ophthalmol. 1996;114(9):1079-84. PMID: 8790092 DOI: 10.1001/archopht.1996.01100140281004
11. Fong DS, Segal PP, Myers F, Ferris FL, Hubbard LD, Davis MD. Subretinal fibrosis in diabetic macular edema: ETDRS report 23. Arch Ophthalmo. 1997;115(7):873-7. PMID: 9230827 DOI: 10.1001/archopht.1997.01100160043006
12. Chen E, Looman M, Laouri M, Gallagher M, Van Nuys K, Lakdawalla D, et al. Burden of illness of diabetic macular edema: literature review. Curr Med Res Opin. 2010;26(7):1587-97. PMID: 20429823 DOI: 10.1185/03007995.2010.482503
13. Falavarjani KG, Iafe NA, Hubschman J-P, Tsui I, Sadda SR, Sarraf D. Optical coherence tomography angiography analysis of the foveal avascular zone and macular vessel density after anti-VEGF therapy in eyes with diabetic macular edema and retinal vein occlusion. Invest Ophthalmol Vis Sci. 2017;58(1):30-4. PMID: 28114569 DOI: 10.1167/iovs.16-20579
14. Alagorie AR, Nittala MG, Velaga S, Zhou B, Rusakevich AM, Wykoff CC, et al. Association of intravitreal aflibercept with optical coherence tomography angiography vessel density in patients with proliferative diabetic retinopathy: a secondary analysis of a randomized clinical trial. JAMA Ophthalmol. 2020;138(8):851-7. PMID: 32584384 DOI: 10.1001/jamaophthalmol.2020.2130
15. Hwang TS, Gao SS, Liu L, Lauer AK, Bailey ST, Flaxel CJ, et al. Automated quantification of capillary nonper-fusion using optical coherence tomography angiography in diabetic retinopathy. JAMA Ophthalmol. 2016;134(4):367–73. PMID: 26795548 DOI: 10.1001/jamaophthalmol.2015.5658
16. Dimitrova G, Chihara E, Takahashi H, Amano H, Okazaki K. Quantitative retinal optical coherence tomography angiography in patients with diabetes without diabetic retinopathy. Invest Ophthalmol Vis Sci. 2017;58(1):190–96. PMID: 28114579 DOI: 10.1167/iovs.16-20531
17. Agemy SA, Scripsema NK, Shah CM, Chui T, Garcia PM, Lee JG, et al. Retinal vascular perfusion density mapping using optical coherence tomography angiography in normals and diabetic retinopathy patients. Retina. 2015;35(11):2353–63. PMID: 26465617 DOI: 10.1097/IAE.0000000000000862
18. Kim AY, Chu Z, Shahidzadeh A, Wang RK, Puliafito CA, Kashani AH. Quantifying microvascular density and morphology in diabetic retinopathy using spectral-domain optical coherence tomography angiography. Invest Ophthalmol Vis Sci. 2016;57(9):362-70. PMID: 27409494 DOI: 10.1167/iovs.15-18904
19. Al-Sheikh M, Akil H, Pfau M, Sadda SR. Swept-source OCT angiography imaging of the foveal avascular zone and macular capillary network density in diabetic retinopathy. Invest Ophthalmol Vis Sci. 2016;57(8):3907–13. PMID: 27472076 DOI: 10.1167/iovs.16-19570
20. Mastropasqua R, Toto L, Mastropasqua A, Aloia R, De Nicola C, Mattei PA, et al. Foveal avascular zone area and parafoveal vessel density measurements in different stages of diabetic retinopathy by optical coherence tomography angiography. Int J Ophthalmol. 2017;10(10): 1545–51. PMID: 29062774 DOI: 10.18240/ijo.2017.10.11
21. Yanik Odabas O, Demirel S, Ozmert E, Batioglu F. Repeatability of automated vessel density and superficial and deep foveal avascular zone area measurements using optical coherence tomography angiography: diurnal findings. Retina. 2018;38(6):1238–45. DOI: 10.1097/IAE.0000000000001671
22. Reddy RK, Pieramici DJ, Gune S, Ghanekar A, Lu N, Quezada-Ruiz C, et al. Efficacy of ranibizumab in eyes with diabetic macular edema and macular nonperfusion in RIDE and RISE. Ophthalmology. 2018;125(10):1568-74. PMID: 29752001 DOI: 10.1016/j.ophtha.2018.04.002
23. Campochiaro PA, Wykoff CC, Shapiro H, Rubio RG, Ehrlich JS. Neutralization of vascular endothelial growth factor slows progression of retinal nonperfusion in patients with diabetic macular edema. Ophthalmology. 2014;121(9):1783-9. PMID: 24768239 DOI: 10.1016/j.ophtha.2014.03.021
24. AttaAllah HR, Mohamed AAM, Ali MA. Macular vessels density in diabetic retinopathy: quantitative assessment using optical coherence tomography angiography. Int Ophthalmol. 2019;39(8):1845-59. PMID: 30194547 DOI: 10.1007/s10792-018-1013-0
25. Couturier A, Rey P-A, Erginay A, Lavia C, Bonnin S, Dupas B, et al. Widefield OCT-angiography and fluorescein angiography assessments of nonperfusion in diabetic retinopathy and edema treated with anti–vascular endothelial growth factor. Ophthalmology. 2019;126(12):1685-94. PMID: 31383483 DOI: 10.1016/j.ophtha.2019.06.022
26. Ashraf M, Sampani K, Clermont A, Abu-Qamar O, Rhee J, Silva PS, et al. Vascular Density of Deep, Intermediate and Superficial Vascular Plexuses Are Differentially Affected by Diabetic Retinopathy Severity. Invest Ophthalmol Vis Sci. 2020;61(10):53. PMID: 32866267 DOI: 10.1167/iovs.61.10.53
27. Tsai AS, Jordan-Yu JM, Gan AT, Teo KY, Tan GS, Lee SY, et al. Diabetic Macular Ischemia: Influence of Optical Coherence Tomography Angiography Parameters on Changes in Functional Outcomes Over One Year. Invest Ophthalmol Vis Sci. 2021;62(1):9. PMID: 33404598 DOI: 10.1167/iovs.62.1.9
28. Hsieh Y-T, Alam MN, Le D, Hsiao CC, Yang CH, Chao DL, et al. OCT angiography biomarkers for predicting visual outcomes after ranibizumab treatment for diabetic macular edema. Ophthalmol Retina. 2019;3(10):826-34. PMID: 31227330 DOI: 10.1016/j.oret.2019.04.027
29. Sorour OA, Sabrosa AS, Yasin Alibhai A, Arya M, Ishibazawa A, Witkin AJ, et al. Optical coherence tomography angiography analysis of macular vessel density before and after anti-VEGF therapy in eyes with diabetic retinopathy. Int Ophthalmol. 2019;39(10):2361-71. PMID: 31119505 DOI: 10.1007/s10792-019-01076-x

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