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

Table 4

Relative strengths and limitations of identified studies.

Study	Strengths	Limitations	Ref.
Ghasemi Falavarjani et al.	Prospective.	Small number of eyes, used various types of VEGF inhibitors, included 2 different etiologies for macular edema, short duration of treatment, used built-in machine VD measurements, and did not exclude patients previously treated with anti-VEGF.	[32]
Sorour et al.	Relatively large number of eyes and used both and scans.	Retrospective, short follow-up period, variable anti-VEGF agent used, variable injection interval, used built-in machine VD measurements, did not exclude patients previously treated with anti-VEGF.	[33]
Hsieh et al.	Relatively large number of eyes, used a custom developed software, used one anti-VEGF agent, included one eye of each patient, assessed multiple outcome measures.	Retrospective, used only scans and did not use automated image alignment.	[34]
Conti et al.	Used one anti-VEGF agent, had a long duration of follow-up, assessed two treatment protocols.	Retrospective, small number of eyes, used only scans, used built-in machine VD measurements, did not exclude patients previously treated with anti-VEGF.	[35]
Michalska and Heinke	Used one anti-VEGF agent, included one eye of each patient.	Retrospective, small number of eyes, used only scans, used variable number of injections, used built-in machine VD measurements.	[36]
Zhu et al.	Prospective, divided patients into ischemic and nonischemic groups, included one eye of each patient, used one anti-VEGF agent.	Used only scans, did not use automated image alignment, used built-in machine VD measurements.	[37]
Mirshani et al.	Prospective, used one anti-VEGF agent, assessed multiple outcome measures.	Small number of eyes, short follow-up period, used only scans, included both eyes of some patients, did not exclude patients previously treated with anti-VEGF.	[38]
Couturier et al.	Prospective.	Small number of eyes, included both eyes of some patients, used only scans, used 2 anti-VEGF agents, used built-in machine VD measurements.	[39]
Elnahry et al. (the IMPACT study)	Prospective, registered, relatively large number of eyes, automated image alignment, used a custom developed software, used both and scans, used one anti-VEGF agent, patients were treatment-naïve, assessed multiple outcome measures.	Included both eyes of some patients and short follow-up period.	[40]
Pereira et al.	Prospective, relatively long follow-up period, used a single anti-VEGF agent, used microperimetry and fluorescein angiography.	Small number of eyes, assessed FAZ only, not all eyes were treatment naïve.	[41]
Elnahry et al.	Prospective, fellow eye used as control, long duration of follow-up, treatment naïve patient.	Small number of eyes, used built-in machine VD measurements.	[12]
Barash et al.	Only study to assess effect on VD immediately after the injection.	Retrospective, small number of eyes, short duration of follow-up, variable etiologies included, used built-in machine VD measurements, used 2 anti-VEGF agents.	[42]
Statler et al.	Prospective, long follow-up period, used a single anti-VEGF agent.	Small number of eyes, used only scans, used built-in machine VD measurements, did not exclude patients previously treated with anti-VEGF.	[43]
Golshani et al. (SWAP-TWO study)	Prospective, long follow-up period, used a single anti-VEGF agent.	Small number of eyes, used only scans, used built-in machine VD measurements, did not exclude patients previously treated with anti-VEGF.	[44]
Busch et al.	Used a single anti-VEGF agent, included one eye of each patient, patients were treatment naive.	Retrospective, small number of eyes, used only scans, variable follow-up period, used built-in machine VD measurements.	[45]
Dastiridou et al.	Prospective, used a single anti-VEGF agent, included one eye of each patient.	Small number of eyes, relatively short follow-up period, used built-in machine VD measurements and assessed SCP VD only.	[46]

FAZ: foveal avascular zone; SCP: superficial capillary plexus; VD: vascular density; VEGF: vascular endothelial growth factor.