Choroidal Vascular Remodeling and Retinal Response After Aflibercept Loading in Diabetic Macular Edema

Area of Science:

• Ophthalmology
• Retinal Diseases
• Pharmacological Treatments

Background:

• Diabetic macular edema (DME) is a leading cause of vision loss in diabetic patients.
• Aflibercept is a common treatment for DME, but its effects on choroidal structure are not fully understood.
• Investigating choroidal changes can provide insights into treatment mechanisms and patient response.

Purpose of the Study:

• To examine choroidal alterations following aflibercept treatment in patients with DME.
• To determine the relationship between these choroidal changes and treatment efficacy.

Main Methods:

• Retrospective analysis of 30 treatment-naïve DME patients receiving 5 monthly aflibercept injections.
• Assessment of choroidal and retinal changes using enhanced depth imaging spectral-domain OCT (EDI-SD-OCT) and ultra-widefield indocyanine green angiography (UWF-ICGA).
• Evaluation of subfoveal choroidal thickness (sfCT), choroidal area (TA, LA, SA), choroidal vascularity index (CVI), choroidal vascular density (CVD), choroidal fractal dimension (CFD), central retinal thickness (CRT), and hyperreflective foci (HRF).

Main Results:

• Aflibercept significantly reduced sfCT, TA, LA, and SA, while increasing CVI (P < 0.001).
• Choroidal vascular density (CVD) remained unchanged, but choroidal fractal dimension (CFD) decreased significantly (P < 0.05).
• Reduced TA and SA, along with increased CVI, correlated with CRT reduction and better treatment response (univariate analysis). Reduction in inflammatory HRF was the only significant factor in multivariable analysis.

Conclusions:

• Aflibercept treatment leads to stromal-predominant choroidal thinning and increased CVI in DME patients.
• This choroidal remodeling is potentially linked to DME resolution, possibly mediated by reduced inflammatory HRF.
• Choroidal structural changes offer insights into aflibercept's therapeutic effects in DME.