Table 2.
Study design, methods, and results of studies that found worsening of macular perfusion following injections.
| Study | No. of eyes | Design of study | Imaging modality | Agent used and treatment duration | Outcome measure | Study results | Ref. |
|---|---|---|---|---|---|---|---|
| Couturier et al. | 10 eyes of 9 patients with DME | Prospective observational case series | OCTA (Optovue) 3 × 3 scan using machine software for VD | Ranibizumab or Aflibercept (3 injections) | Change in VD after 3 injections using built-in machine software | SCP VD drop from 39.5 ± 6.9% to 36.6 ± 4.3% and DCP VD from 44.7 ± 6.2% to 42.5 ± 3.8% (p > 0.05) | [39] |
| Elnahry et al. (the IMPACT study) | 40 eyes of 26 patients with DME | Prospective case series with predefined outcome measures | OCTA (Optovue) 3 × 3 and 6 × 6 scans with custom image processing | Bevacizumab (3 monthly injections) | Change in FD, VD, skeleton VD, and manual FAZ area | Increase in FAZ area and decrease in FD, VD, and skeleton VD of full, SCP, and DCP (all p < 0.05) | [40] |
| Pereira et al. | 5 eyes of 5 patients with DME and DMI | Prospective case series | FA, OCTA (Topcon) 3 × 3 or 4.5 × 4.5, and MP | Bevacizumab (6 injections) | Change in FAZ area on FA and OCTA (manually measured in both) | FA FAZ from 1.35 ± 1.44 mm2 to 1.02 ± 1.02 mm2 (p = 0.19) and OCTA FAZ from 0.82 ± 0.55 mm2 to 0.92 ± 0.57 mm2 (p = 0.02) | [41] |
| Elnahry et al. | 2 eyes of 1 patient with DME | Prospective longitudinal case report | OCTA (Optovue) 6 × 6 scan with machine software | Bevacizumab (repeated 3 monthly injections) | Change in built-in machine VD | Reversible worsening of VD with injections | [12] |
| Barash et al. | 9 eyes with PDR and 5 with DME | Retrospective case series | OCTA (Optovue) macular and peri-papillary scans | Bevacizumab or Aflibercept (immediately after injections) | Macular and peri-papillary VD changes | SCP VD dropped by 7.8% while the DCP VD dropped by 3.5% immediately after injection | [42] |
| Statler et al. | 16 eyes of 16 patients with persistent DME | Prospective case series with predefined outcome measures | OCTA (Optovue) 3 × 3 scan using machine software | Aflibercept (fixed interval injections for 24 months) | Change in built-in machine VD and FAZ area | Whole SCP VD decreased by 5.3% and whole DCP VD decreased by 4.4%. FAZ area increased (all p < 0.05) | [43] |
| Golshani et al. (SWAP-TWO study) | 20 eyes of 20 patients with DME | Prospective case series with predefined outcome measures | OCTA (Optovue) 3 × 3 scan using machine software | Aflibercept (monthly dosing till dry then every 2 months thereafter through 12 months) | Change in built-in machine VD and FAZ area | No change in FAZ area, but SCP and DCP VD significantly decreased by 5.2% and 6.3%, respectively (p ≤ 0.05) | [44] |
DCP: deep capillary plexus; DME: diabetic macular edema; DMI: diabetic macular ischemia; FA: fluorescein angiography; FAZ: foveal avascular zone; FD: fractal dimension; Full: full retinal thickness; MP: microperimetry; OCTA: optical coherence tomography angiography; PDR: proliferative diabetic retinopathy; SCP: superficial capillary plexus; VD: vascular density.