Assessment of choriocapillaris/Sattler and Haller layer changes after intravitreal injection in eyes with neovascular age-related macular degeneration: aflibercept vs ranibizumab

Purpose To evaluate the changes in choriocapillaris (CC)/Sattler and Haller layer thicknesses in eyes with neovascular age-related macular degeneration (nAMD) after aflibercept or ranibizumab injections. Study design Retrospective. Methods A total of 70 eyes of 70 patients with treatment-naive exudative nAMD were treated with 3 consecutive injections of aflibercept (IVA) or ranibizumab (IVR). CC/Sattler and Haller layer thicknesses were measured at the nasal and temporal regions 1000 mu m from the center of the fovea by enhanced-depth imaging optical coherence tomography at baseline and after the 3 monthly intravitreal injections. In addition, the hyperfluorescence region (HF) was measured as the largest horizontal diameter of the hyperfluorescence area on the early-middle phase fluorescein angiographic images at baseline and after the 3 loading doses. Results After the 3 consecutive injections, the mean reductions in the nasal/temporal CC/Sattler layer thicknesses in the IVR and IVA groups were - 10.1 +/- 2.3/ - 8.5 +/- 1.8 and - 25.2 +/- 15.2/ - 19.4 +/- 12.8 mu m, respectively. Also, the mean reductions in the nasal/temporal Haller layer thicknesses in the IVR and IVA groups were - 6.5 +/- 3.6/ - 7.2 +/- 7.9 and - 9.5 +/- 8.0/ - 7.0 +/- 6.2 mu m, respectively. The changes in the CC/Sattler layer thicknesses of the IVA group were greater than those of the IVR group (P < .001); however, the changes in the Haller layer thickness were similar between the groups (P > .05). The mean decrease in the HF size of the IVA group was greater than that of the IVR group (P < .001). Conclusions Aflibercept treatment has a more pronounced effect on the CC/Sattler layer. Such results may indicate that aflibercept treatment influences choroidal neovascularization, possibly by reducing the capillary permeability associated with active neovascularization in the CC layer.