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Microvascular Changes After Conbercept Therapy in Central Retinal Vein Occlusion Analyzed by Optical Coherence Tomography Angiography

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Microvascular Changes After Conbercept Therapy in Central Retinal Vein Occlusion Analyzed by Optical Coherence Tomography Angiography Microvascular changes after conbercept therapy ·Clinical Research· Microvascular changes after conbercept therapy in central retinal vein occlusion analyzed by optical coherence tomography angiography Yang Deng1, Qi-Wen Zhong2, Ai-Qi Zhang3, Xiao-Juan Cai4, Ming-Zhi Lu1, Shao-Chong Zhang1, Li-Shi Su1, Hui Chen1, Ying Lin1, Li-Mei Sun1, Guan-Di Chen1, Li-Ting Zhong1, Chen-Jin Jin1, Wei Chi1 1State Key Laboratory of Ophthalmology, Zhongshan significantly lower in CRVO eyes than in healthy eyes, Ophthalmic Center, Sun Yat-sen University, Guangzhou while the AI and retinal thickness were significantly 510060, China higher (all P<0.05). After treatment, retinal thickness was 2Wuping Hospital, Longyan 364300, China significantly decreased, and the mean BCVA had markedly 3The Second Affiliated Hospital of Harbin Medical University, improved from 20/167 to 20/65 (P=0.0092). The flow area of Harbin 150086, China the choriocapillaris was also significantly improved, which 4The People’s Hospital of Gaoyao District, Zhaoqing 526000, may result from the reduction of shadowing effect caused China by the attenuation of macular edema. However, there were Co-first authors: Yang Deng, Qi-Wen Zhong and Ai-Qi no significant changes in SCP and DCP vessel density Zhang after treatment. The flow area of the choriocapillaris at Correspondence to: Wei Chi and Chen-Jin Jin. State Key baseline was negatively correlated with retinal thickness. Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, ● CONCLUSION: OCTA enables the non-invasive, layer- Sun Yat-sen University, 54 Xianlie Road, Guangzhou 510060, specific and quantitative assessment of microvascular Guangdong Province, China. [email protected]; changes both before and after treatment, and can therefore [email protected] be used as a valuable imaging tool for the evaluation of Received: 2018-08-19 Accepted: 2018-12-15 the follow-up in CRVO patients. ● KEYWORDS: central retinal vein occlusion; optical coherence Abstract tomography angiography; macular edema; conbercept; vessel ● AIM: To investigate microvascular changes in eyes with density; flow area; foveal avascular zone central retinal vein occlusion (CRVO) complicated by DOI:10.18240/ijo.2019.05.16 macular edema before and after intravitreal conbercept injection and evaluate correlations between these changes Citation: Deng Y, Zhong QW, Zhang AQ, Cai XJ, Lu MZ, Zhang SC, and best-corrected visual acuity (BCVA) and retinal Su LS, Chen H, Lin Y, Sun LM, Chen GD, Zhong LT, Jin CJ, Chi W. thickness. Microvascular changes after conbercept therapy in central retinal vein ● METHODS: Twenty-eight eyes of 28 patients with macular occlusion analyzed by optical coherence tomography angiography. Int edema caused by CRVO were included in this retrospective J Ophthalmol 2019;12(5):802-808 study. All patients received a single intravitreal conbercept injection to treat macular edema. BCVA and the results INTRODUCTION of optical coherence tomography angiography (OCTA) entral retinal vein occlusion (CRVO) is a common automatic measurements of the vessel density in the C sight-threatening retinal vascular disorder that can lead superficial (SCP) and deep retinal capillary plexus (DCP), to severe visual impairment or even blindness[1]. Because it the foveal avascular zone (FAZ) area, the FAZ perimeter obstructs the central retinal venous outflow, CRVO induces (PERIM), the vessel density within a 300-μm wide ring fairly severe macular edema, which is the predominant cause surrounding the FAZ (FD-300), the acircularity index (AI), of visual deterioration[2-3]. Nevertheless, timely treatment the choriocapillaris flow area, and retinal thickness were of macular edema significantly improves visual prognoses. recorded before and at one month after treatment and Currently, intravitreal anti-vascular endothelial growth factor compared with the results observed in age- and sex- (VEGF) is a revolutionary treatment for macular edema matched healthy subjects. secondary to CRVO. Conbercept, a novel and effective anti- ● RESULTS: The vessel density in the SCP and DCP, the VEGF agent, is a fusion protein that blocks all isoforms of FD-300, and the flow area of the choriocapillaris were all VEGF-A, VEGF-B, VEGF-C, and placental growth factor 802 Int J Ophthalmol, Vol. 12, No. 5, May 18, 2019 www.ijo.cn Tel: 8629-82245172 8629-82210956 Email: [email protected] (PIGF) and exhibits a substantially high blinding affinity formally reviewed and approved by the Ethics Committee for VEGF and a long half-life in the vitreous humor, and of Zhongshan Ophthalmic Center (Guangzhou, China it has been broadly used in China[4]. Therefore, intravitreal 2017KYPJ101) and conducted in accordance with the tenets injection with conbercept represents an excellent option with of the Declaration of Helsinki. Written informed consent was a satisfactory safety profile and efficacy when used to treat obtained from each participant prior to enrollment in the study. macular edema to improve visual acuity in CRVO[5-6]. Although Subjects In this study, twenty-eight patients with unilateral many features of CRVO have been extensively evaluated CRVO complicated by macular edema diagnosed based using fundus photography, spectral domain optical coherence on a history, ophthalmoscopy, and FA were enrolled at the tomography (SD-OCT), and fluorescein angiography (FA), Zhongshan Ophthalmic Center from November 2016 through potential abnormalities in the retinal microvasculature cannot May 2018. When the non-perfused area was larger than 10-disc be comprehensively identified using these techniques. areas on FA, CRVO was defined as an ischemic type. A group Recently, optical coherence tomography angiography (OCTA) of 28 age- and sex-matched healthy subjects were included was introduced as a non-invasive, promising imaging technique as a control group. All patients received a single intravitreal that enables the detection of retinal and choroidal diseases conbercept injection to treat macular edema at the initial visit and allows more detailed imaging of vascular microstructures and were followed up as the post-injection group at one month without the use of exogenous dyes compared to FA[7]. More after treatment. recently, the AngioAnalytics software was upgraded, and can The main inclusion criterion was the presence of macular now automatically detect the foveal avascular zone (FAZ) edema associated with CRVO that was treated by an margin and quantify the latest FAZ parameters, including the intravitreal injection of conbercept. In addition, we required foveal avascular zone perimeter (PERIM), the acircularity the central retina thickness to be greater than or equal to index (AI), and the vessel density within a 300-μm width ring 320 μm based on the methods described by Sun et al[5]. The surrounding the FAZ (FD-300). exclusion criteria were eyes with branch retinal vein occlusion, Several previous clinical studies used OCTA to evaluate the hemi-CRVO, retinal arterial occlusion, previous retinal retinal vascular changes that occur in CRVO, which include surgery, ocular trauma or other coexisting ocular disorders, microaneurysms, telangiectasia, FAZ area and macular non- such as severe diabetic retinopathy, epiretinal membrane, perfusion area (NPA)[8-10]. Recently, the short-term changes retinitis pigmentosa, age-related macular degeneration (AMD), in the FAZ area and macular vessel density in eyes with polypoidal choroidal vasculopathy (PCV), glaucoma, and macular edema due to diabetic retinopathy or CRVO after a pathologic myopia, that could affect the interpretation of single intravitreal injection of bevacizumab, aflibercept or OCTA quantitative parameters. Moreover, patients with poor- ranibizumab were reported by Ghasemi Falavarjani quality OCTA images because of eye movements, significant et al[11]. However, no previous study has performed a follow- media opacities or incorrect autosegmentation were also up analysis of patients with CRVO complicated by macular excluded from this study. edema who were treated with the novel anti-VEGF drug A complete ophthalmic examination, including the assessment conbercept and evaluated using OCTA. It also remains unclear of BCVA using a Snellen chart, slit-lamp biomicroscopy, what changes occur in these novel FAZ parameters quantified intraocular pressure, indirect fundus ophthalmoscopy based on a retinal slab instead of the separated superficial and OCTA (Software Version 2017.1, RTVue XR Avanti, retinal capillary plexus (SCP) and deep retinal capillary plexus AngioVue; Optovue, Inc., Fremont, CA, USA) was performed (DCP) between before and after treatment and whether these before and at one month after intravitreal injection of changes affect visual function. conbercept in CRVO eyes, as well as in control eyes. Therefore, in the current study, we aimed to use OCTA to Optical Coherence Tomography Angiography Using quantitatively analyze changes in the retinal microvasculature default settings in the OCTA system, an SCP image was taken in CRVO patients with macular edema who were treated to encompass the areas from the internal limiting membrane with conbercept and evaluate correlations between these (ILM) to -10 μm below the inner plexiform layer (IPL), a changes and best-corrected visual acuity (BCVA) and retinal DCP image was taken from -10 μm below the IPL to 10 μm thickness. In addition, we for the first time reported the latest below the outer plexiform layer (OPL), the outer retina slab FAZ parameters in CRVO eyes before and after anti-VEGF (for avascular
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