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Quantitative response of macular neovascularisation to loading phase of aflibercept in neovascular age-related macular degeneration

Eye (2023)Cite this article

Subjects

Abstract

Purpose

To evaluate quantitative morphological changes in macular neovascularisation (MNV) network after aflibercept therapy in neovascular age-related macular degeneration (nAMD) patients.

Methods

Consecutive treatment-naïve patients with optical coherence tomography (OCT) angiography confirmed MNV due to nAMD who completed a loading phase of intravitreal aflibercept injections. A quantitative analysis of the vascular network remodelling was performed using a computational software (Angiotool).

Results

A total of 53 eyes of 52 patients were included in the analysis. The total MNV area decreased significantly after three aflibercept injections (p = 0.003). Total vessel area and vessel density decreased respectively of 20% and 12% at V3 (p < 0.001 in both cases). Other parameters that reduced significantly were total vessel length, average vessel length and density of vascular junctions (p = 0.018, p = 0.002, and p = 0.044, respectively). The number of vascular endpoints (p = 0.001) and lacunarity (p = 0.011) increased significantly, whilst the number of vascular junctions did not vary significantly (p = 0.068). Changes in vascular metrics were predominantly driven by MNV type 1 and 2. No clear relationship was observed between any of the vascular metrics and the macular fluid status.

Conclusion

Although objective quantification of vascular parameters showed a significant remodelling of the MNV post-loading phase of aflibercept in type 1 and 2 MNV subtypes, none of the quantified vascular metrics correlated to the macular fluid response. These findings highlight a dissociation of anti-angiogenic and anti-permeability properties of aflibercept therapy during the loading phase.

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Fig. 1: Images processing and analysis.
Fig. 2: Box plot analysis of macular neovascularisation metrics variation over time.
Fig. 3: Example of MNV remodelling over the aflibercept loading dose.

Data availability

The dataset generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, UK

    Andrea Montesel, Ahmed M. Hagag, Shruti Chandra, Raheeba Pakeer Muhammed, Sridevi Thottarath, Swati Chandak & Sobha Sivaprasad

  2. Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK

    Ahmed M. Hagag, Shruti Chandra & Sobha Sivaprasad

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Contributions

AM, AMH and SS designed the study, analysed data, wrote and reviewed the paper. AM, AMH, SC, RPM, ST, SC collected the data. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Sobha Sivaprasad.

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Competing interests

SS received consultancy fees from Bayer, Allergan, Novartis Pharma AG, Roche, Boehringer Ingelheim, Optos, Apellis, Oxurion, Oculis and Heidelberg Engineering. SS is Editor-in-Chief for the journal Eye. All the other authors declare no competing interests.

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Montesel, A., Hagag, A.M., Chandra, S. et al. Quantitative response of macular neovascularisation to loading phase of aflibercept in neovascular age-related macular degeneration. Eye (2023). https://doi.org/10.1038/s41433-023-02574-0

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