Reduced Vessel Density of the Choriocapillaris during Anti-Vascular Endothelial Growth Factor Therapy for Neovascular Age-Related Macular Degeneration

Purpose: To investigate macular vascular alterations by using optical coherence tomography angiography (OCTA) in patients with a history of long-term anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (nAMD). Methods: Japanese patients with nAMD with a history of long-term anti-VEGF monotherapy at study entry were studied retrospectively. OCTA images were obtained, and the vessel densities (mm-1) of the superficial capillary plexus, deep capillary plexus (DCP), choriocapillaris (CC), and the plexus foveal avascular zone area (mm2) were calculated. Results: One hundred twenty-four eyes (124 patients) were included. The mean ± standard deviation follow-up period between the first and last OCTA imaging sessions was 14.5 ± 3.1 months; the duration of the anti-VEGF monotherapy before the first OCTA imaging session was 68.0 ± 23.6 months, with a mean of 3.6 ± 3.0 injections during the follow-up period. The vessel densities of the DCP and CC significantly decreased (P = 0.001 and P = 0.009, respectively) from 10.62 ± 2.72 mm-1 and 11.84 ± 1.79 mm-1 to 9.44 ± 2.88 mm-1 and 11.18 ± 2.12 mm-1. Such findings were not observed in 63 control eyes. Conclusions: The DCP and CC deteriorate during treatment. This information may guide future treatment strategies for nAMD, such as the need to protect the capillaries to maintain visual acuity after long-term treatment. Prospective, controlled trials are required to confirm our findings.