Choroidal thickness decreases after five anti-VEGF injections
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Choroidal thickness decreased in patients with diabetic macular edema after five intravitreal injections of anti-VEGF, according to a study published in the Journal of Ophthalmology.
“The first-line therapy of central [diabetic macular edema] DME with decreased visual acuity is usually based on intravitreal injections (IVI) of anti-VEGF that have proved their efficacy on visual impairment reduction. Ranibizumab and aflibercept, the two anti-VEGFs currently used in France, have been shown to be effective in reducing DME and improving vision in eyes with DME,” Valerie Sarda, Hopital Avicenne, Centre Ophthalmologique Saint Paul Bastille, and colleagues wrote.
The authors said they sought to assess the efficacy of ranibizumab and aflibercept on the choroidal thickness (CT) in treatment-naive patients with DME.
In a prospective, single-center study, researchers analyzed 24 eyes (mean age, 61.1 years) with DE vision loss from DME. Patients received five IVI doses of either ranibizumab (n = 11) or aflibercept (n = 13) over the course of 5 months. Researchers measured change in central subfield CT (CSCT) between inclusion and 1 month after the final IVI dose as well as CT changes in other locations. Researchers further compared results between the ranibizumab group, the aflibercept group and a control group of 15 eyes.
Study results showed an overall CSCT decrease by 12 µm between inclusion and 5 months (231.7 µm vs. 219.7 µm, respectively; P= .03). Further, CSCT decreased by 15.2 µm (206.9 µm vs. 191.7 µm, respectively; P= .02) in the aflibercept group, by 7.3 µm (267.5 µm vs. 260.2 µm, respectively; P= .4) in the ranibizumab group and by 4.9 µm (242.3 µm vs. 237.4 µm, respectively) in noninjected contralateral eyes. Investigators reported CT changes in the superior, temporal, inferior and nasal macular inner ring were significant in the aflibercept group alone.
“The central CT decreases in DME eyes treated with anti-VEGF IVI in this series, especially in case of treatment with aibercept,” Sarda and colleagues concluded.
Perspective
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Identification of DME requires prompt treatment, and the findings in this study may help direct our choice of therapeutic agent. As clinicians, we usually concentrate on retinal thickness changes when monitoring a patient for resolution of DME; however, this paper focuses specifically on the effect of ranibizumab and aflibercept on choroidal thickness. It is one of the first studies to directly compare anti-VEGF drugs in this regard. While limited in its sample size of only 22 eyes, the authors demonstrated a reduction of choroidal thickness in both drug groups with a statistically significant decrease only in the aflibercept group.
This finding may seem to suggest that aflibercept is the treatment of choice in DME; however, the authors caution that a decreased choroidal thickness likely corresponds to narrowing of the choroidal vasculature, a finding that may be detrimental to the photoreceptor health in an already oxygen-deprived retina. An increased number of study participants, a longer follow-up period and a correlation between choroidal thickness and visual recovery would help to enhance these results. While the findings of this study may lay some groundwork for potentially directing our clinical recommendations in the future, it is too early to routinely endorse aflibercept as the superior therapy for DME patients.
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