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

Table 2

Study design, methods, and results of studies that found worsening of macular perfusion following injections.

Study	No. of eyes	Design of study	Imaging modality	Agent used and treatment duration	Outcome measure	Study results	Ref.
Couturier et al.	10 eyes of 9 patients with DME	Prospective observational case series	OCTA (Optovue) scan using machine software for VD	Ranibizumab or Aflibercept (3 injections)	Change in VD after 3 injections using built-in machine software	SCP VD drop from to and DCP VD from to ()	[39]
Elnahry et al. (the IMPACT study)	40 eyes of 26 patients with DME	Prospective case series with predefined outcome measures	OCTA (Optovue) and scans with custom image processing	Bevacizumab (3 monthly injections)	Change in FD, VD, skeleton VD, and manual FAZ area	Increase in FAZ area and decrease in FD, VD, and skeleton VD of full, SCP, and DCP (all )	[40]
Pereira et al.	5 eyes of 5 patients with DME and DMI	Prospective case series	FA, OCTA (Topcon) or , and MP	Bevacizumab (6 injections)	Change in FAZ area on FA and OCTA (manually measured in both)	FA FAZ from to () and OCTA FAZ from to ()	[41]
Elnahry et al.	2 eyes of 1 patient with DME	Prospective longitudinal case report	OCTA (Optovue) scan with machine software	Bevacizumab (repeated 3 monthly injections)	Change in built-in machine VD	Reversible worsening of VD with injections	[12]
Barash et al.	9 eyes with PDR and 5 with DME	Retrospective case series	OCTA (Optovue) macular and peri-papillary scans	Bevacizumab or Aflibercept (immediately after injections)	Macular and peri-papillary VD changes	SCP VD dropped by 7.8% while the DCP VD dropped by 3.5% immediately after injection	[42]
Statler et al.	16 eyes of 16 patients with persistent DME	Prospective case series with predefined outcome measures	OCTA (Optovue) scan using machine software	Aflibercept (fixed interval injections for 24 months)	Change in built-in machine VD and FAZ area	Whole SCP VD decreased by 5.3% and whole DCP VD decreased by 4.4%. FAZ area increased (all )	[43]
Golshani et al. (SWAP-TWO study)	20 eyes of 20 patients with DME	Prospective case series with predefined outcome measures	OCTA (Optovue) scan using machine software	Aflibercept (monthly dosing till dry then every 2 months thereafter through 12 months)	Change in built-in machine VD and FAZ area	No change in FAZ area, but SCP and DCP VD significantly decreased by 5.2% and 6.3%, respectively ()	[44]

DCP: deep capillary plexus; DME: diabetic macular edema; DMI: diabetic macular ischemia; FA: fluorescein angiography; FAZ: foveal avascular zone; FD: fractal dimension; Full: full retinal thickness; MP: microperimetry; OCTA: optical coherence tomography angiography; PDR: proliferative diabetic retinopathy; SCP: superficial capillary plexus; VD: vascular density.