Work

Choroidal Vascular Remodeling and Retinal Response After Aflibercept Loading in Diabetic Macular Edema

Year: 2025

Type: article

Abstract: Purpose: To investigate choroidal changes following aflibercept treatment for diabetic macular edema (DME) and to assess their association with treatment response. Design: Retrospective interventional cohort studySubjects: Thirty eyes from 30 patients who were injection-naïve for DME and received initial five monthly loading injections of aflibercept.Methods: Choroidal and retinal changes following loading injections were analyzed using spectral-domain optical coherence tomography with enhanced depth imaging (EDI-SD-OCT) and ultra-widefield-indocyanine green angiography (UWF-ICGA).The correlation between choroidal and retinal changes, along with factors associated with a good treatment response, was investigated.Main Outcome Measures: Changes in subfoveal choroidal thickness (sfCT), total choroidal area (TA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI) measured by EDI-SD-OCT, choroidal vascular density (CVD) and fractal dimension (CFD) of macula and wide-field assessed byUWF-ICGA, as well as treatment response, including CRT and inflammatory hyperreflective foci (HRF) evaluated through EDI-SD-OCT.Results: Aflibercept induced a significant reduction in sfCT, TA, LA, and SA (all p < 0.001), accompanied by an increase in CVI (p = 0.005) on EDI-SD-OCT.On UWF-ICGA, CVD showed no significant change in either macular or wide-field (p = 0.127 and 0.517, respectively), while CFD significantly decreased in both fields (p = 0.033 and 0.040, respectively).Decrease in TA, especially SA, and consequent CVI increase were significant factors associated with CRT reduction (p=0.017,0.004, and 0.044) and good treatment response in univariate analysis (p = 0.049,0.026,and 0.047); however, only the reduction in inflammatory HRF maintained significance in multivariable analysis (p = 0.021 and 0.045).The reduction in inflammatory HRF was significantly associated with the decrease in TA, LA J o u r n a l P r e -p r o o f

Source: Ophthalmology Science

DOI: 10.1016/j.xops.2025.101025