Journal of Diabetes Research

Review Article

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

Table 1

Study design, methods, and results of studies that found stable or improved macular perfusion following injections.


Study	No. of eyes	Design of study	Imaging modality	Agent used and treatment duration	Outcome measure	Study results	Ref.

Ghasemi Falavarjani et al.	13 eyes of 10 patients with DME	Prospective noncomparative case series	OCTA (Optovue) using VD from machine software	Bevacizumab, Ranibizumab, Aflibercept (1 injection by any)	Change in FAZ area (manual) and VD	FAZ-A increased, and VD of foveal area decreased but nonsignificantly (p>0.05)	[32]
Sorour et al.	55 eyes of 35 patients with DME or PDR	Retrospective case series	OCTA (Optovue) and scans with VD of machine	45.7% Bevacizumab, 42.4% Aflibercept, and 11.9% Ranibizumab	Change in VD after 3 injections	No significant change in VD measurements at 1, 2, and 3 months	[33]
Hsieh et al.	50 eyes of 50 patients with DME	Retrospective case series	OCTA (Optovue) with custom developed Matlab software for image processing and analysis	Ranibizumab (3 injections)	Change in FAZ-A, FAZ-CI, AVC, vascular tortuosity, and VD	Improvement of FAZ-A (-31%), AVC (-4.3%), and inner (+5.9%) and outer (+8.8%) PF-VD in the SCP, and FAZ-A (-31%), FAZ-CI (-4.2%), and inner (+9.1%) and outer (+9.4%) PF-VD in DCP ()	[34]
Conti et al.	19 eyes of 19 patients with DR	Retrospective case series	OCTA (Optovue) scan using built-in machine VD	Aflibercept (by 12 months, 26% received monthly while 74% received bimonthly treatment)	Change in FAZ and VD after 6 and 12 months of treatment	FAZ area enlarged from 0.307 to 0.313 mm², VD dropped from 46.9% to 45.7% ()	[35]
Michalska and Heinke	3 eyes of 3 patients with DME	Retrospective case series	OCTA (Optovue) scans	Aflibercept (3-5 injections)	Change in built-in machine VD	Insignificant change in VD ()	[36]
Zhu et al.	50 eyes of 50 patients with DME (ischemic and nonischemic)	Prospective case series with predefined outcome measures	OCTA (Optovue) scan using machine software	Conbercept (3 monthly injections then pro re nata for 3 months)	Change in built-in machine VD and FAZ area	FAZ area significantly decreased and superficial capillary plexus VD increased in ischemic group (both )	[37]
Mirshani et al.	23 eyes of 19 patients with DME	Prospective case series with predefined outcome measures	OCTA (Optovue) scan using machine software and custom image processing	Bevacizumab (single injection)	Change in built-in machine VD, manual FAZ area, VDI, and VLD index	No significant change in FAZ area, retinal VD, VDI, or VLD (all ). Improved subfoveal choriocapillaris VD ()	[38]

AVC: average vessel caliber; DCP: deep capillary plexus; DME: diabetic macular edema; DR: diabetic retinopathy; FA: fluorescein angiography; FAZ: foveal avascular zone; FAZ-A: foveal avascular zone area; FAZ-CI: foveal avascular zone circulatory index; OCTA: optical coherence tomography angiography; PDR: proliferative diabetic retinopathy; PF: parafoveal; SCP: superficial capillary plexus; VD: vascular density; VDI: vessel diameter index; VLD: vascular length density.