Optical coherence tomography angiography to quantify choroidal neovascularization in response to aflibercept

Purpose: To investigate the microvascular changes in choroidal neovascularization (CNV) using optical coherence tomography angiography (OCTA) during anti-vascular endothelial growth factor (VEGF) therapies. Methods: We retrospectively collected data on consecutive treatment-naïve eyes with typical age-related macular degeneration that initially received 3 aflibercept injections. OCTA was performed at baseline and at 1, 2, and 4 months of follow-up. The CNV images were analyzed using open-source software to assess vessel area and junction density. Results: Fifteen eyes of 15 patients were included. The mean vessel area at baseline was 0.50 ± 0.33 mm²; at 1, 2, and 4 months, the ratios of change in vessel area from baseline were 66.6 ± 38.8%, 80.5 ± 25.5%, and 94.0 ± 29.3%, respectively. The vessel area was significantly reduced at 1 month from that at baseline (p = 0.0015) but significantly increased at 4 months from that at 1 month (p = 0.011). The mean junction density was also significantly reduced from 4.70 ± 1.30/mm at baseline to 3.82 ± 1.06/mm at 1 month (p = 0.00084). However, junction density did not continue to decrease at 2 and 4 months. Conclusion: OCTA quantification revealed that CNV rebounded after repeat aflibercept injections despite shrinking in response to the first injection.