May 15, 2020
2 min read

Foveal capillary perfusion density decreases in DME patients treated with aflibercept

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Even when switched to a 2-month intravitreal injection regimen of aflibercept, patients with resolved diabetic macular edema continued to experience capillary perfusion density loss and increased foveal avascular zone areas through 24 months, according to a presenter at the virtual Association for Research in Vision and Ophthalmology meeting.

“Although capillary perfusion density is a relatively new biomarker for monitoring diabetic retinopathy, and further studies defining clinical correlations are needed, the findings from this study support initiating anti-VEGF therapy earlier in patients with center-involving diabetic macular edema,” Brittney Statler, MD, said.

In the prospective SWAP-TWO study, Statler and colleagues included 20 eyes with persistent DME despite prior treatment with bevacizumab or ranibizumab. Patients received intravitreal aflibercept injections every 4 weeks until DME resolution and were then switched to an extended fixed-dosing regimen of every 8 weeks.

Statler and colleagues evaluated the primary outcome measure of mean change in central subfield thickness from baseline to 24 months and secondary outcomes measures of mean change in best corrected visual acuity, mean change in OCT angiography (OCTA) capillary perfusion density (CPD) and mean change in OCTA foveal avascular zone areas.

Sixteen patients completed the study through 24 months and received a mean 15.2 intravitreal aflibercept injections. The average central subfield thickness improved from 420 µm at baseline to 251 µm at 24 months, a statistically significant difference (P < .001). Eyes experienced a statistically significant increase in BCVA from baseline to 24 months, gaining an average of 5.5 letters (P = .042).

Statler said OCTA measurements revealed a loss of CPD in both superficial and deep layers from baseline to 24 months despite a change to the fixed-dosing regimen of every 8 weeks. OCTA also revealed a statistically significant increase in area of the foveal avascular zones from baseline to 24 months.

Parafoveal and foveal plus parafoveal CPD, “whole” CPD, decreased by 5.3% from baseline, a statistically significant decrease (P = .001). Additionally, deep CPD experienced a statistically significant decrease of 4.4% by 24 months (P = .009), Statler said.

“Less superficial foveal and parafoveal capillary perfusion density loss were correlated with better final best corrected visual acuity,” Statler said. – by Robert Linnehan



Statler B. Foveal capillary perfusion density decreases in diabetics with DME treated on a fixed regimen of intravitreal aflibercept injections over 24 months. Presented at: Association for Research in Vision and Ophthalmology annual meeting; May 6, 2020 (virtual meeting).

Disclosure: Statler reports no relevant financial disclosures.