Ultra-Wide Field (UWF) Fluorescein Angiographic Non-Perfusion Status After Endolaserless Vitrectomy and Aflibercept Monotherapy for Eyes with Proliferative Diabetic Retinopathy (PDR)-related Vitreous Hemorrhage (VH)
Recommended Citation
Qin L, Kasetty VM, Davis S, Blodi BA, and Marcus DM. Ultra-Wide Field (UWF) Fluorescein Angiographic Non-Perfusion Status After Endolaserless Vitrectomy and Aflibercept Monotherapy for Eyes with Proliferative Diabetic Retinopathy (PDR)-related Vitreous Hemorrhage (VH). Invest Ophthalmol Vis Sci 2024; 65(7):1754.
Document Type
Conference Proceeding
Publication Date
6-2024
Publication Title
Investig Ophthalmol Vis Sci
Abstract
Purpose: The effect of anti-vascular endothelial growth factor (anti-VEGF) therapy on retinal non-perfusion in PDR remains ill-defined. We report 3-year UWF fluorescein angiogram (FA) gradings of retinal non-perfusion in eyes randomized in the LASERLESS trial. This provides a unique opportunity to determine the effects of intravitreal aflibercept injection (IAI) monotherapy on retinal ischemia in severe PDR eyes.
Methods: Eligible eyes with PDR-related VH underwent vitrectomy without panretinal photocoagulation (PRP) endolaser with 1 pre- and 1 intraoperative IAI were randomized to postoperative q8- or q16-week IAI monotherapy. Prospectively planned UWFFA's were performed at 4 weeks (baseline) after vitrectomy and then quarterly throughout the 3- year period. Images were independently graded by the Wisconsin Reading Center for nonperfusion index (NPI), foveal avascular zone integrity, leakage, and neovascularization.
Results: A total of 31 eyes (14 and 17 in q8- and q16-week groups, respectively) were randomized. Through 3 years, q8-week and q16-week eyes received 19 and 12 IAI, respectively. Among all patients, NPI increased from 19.1% at baseline to 22.6%, 27.5%, 31.0% at years 1, 2, and 3, respectively (p=0.086, <0.001, <0.001 for change from baseline, respectively). While NPI increased in both the q8-week and q16-week groups at 3 years, NPI progression was less in q8-week eyes with average increase in NPI of 6.3% compared to 10.3% in q16-week eyes (p=0.283). There is an overall trend toward reduced NPI progression with increased aflibercept injection burden over 3 years.
Conclusions: More frequent aflibercept dosing resulted in reduced proliferative consequences and reduced NPI progression. Although NPI progression was reduced with more frequent IAI, peripheral retinal non-perfusion continues despite persistent antiVEGF therapy. Our study suggests that anti-VEGF does not reverse retinal ischemia despite a high therapy burden.
Volume
65
Issue
7
First Page
1754
