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 (mm(2)) 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.