The Effect of Intravitreal Aflibercept on Ocular Perfusion – a Pilot Study

Session Details

Session Title: Free Paper Session 3: AMD I

Session Date/Time: Thursday 07/09/2017 | 08:30-10:00

Paper Time: 09:36

Venue: Room 118

First Author: : N.Luft AUSTRIA

Co Author(s): :    A. Mursch-Edlmayr   M. Ring   R. Strauss   L. Schmetterer   M. Bolz                 

Abstract Details

Purpose:

Aim of this study was to assess the effect of the intravitreal anti-VEGF agent aflibercept for the treatment of neovascular age-related macular degeneration (nAMD) on ocular perfusion. Besides its role in the pathogenesis of nAMD, VEGF acts as a physiologic vasodilator by activating endothelial nitric oxide synthase. As a consequence, VEGF inhibition should result in significant ocular vasoconstriction, which has in fact been demonstrated for bevacizumab and ranibuzumab. Aflibercept offers a superior binding affinity for VEGF as compared with the aforementioned anti-VEGF agents. However, as of today, its effect on ocular circulation is entirely unclear.

Setting:

Department of Ophthalmology, Kepler University Clinic, Linz, Austria

Methods:

This study included a total of 20 patients with unilateral nAMD that were scheduled for three consecutive monthly intravitreal aflibercept injections. Laser Speckle Flowgraphy (LSFG) was employed for the non-invasive monitoring of chorioretinal perfusion at the macula as well as of optic nerve head perfusion. In conjunction with LSFG scans, measurements of systemic blood pressure and intraocular pressure (IOP) were taken in order to estimate ocular perfusion pressure (OPP). Measurements were obtained prior to the first injection as well as 5 minutes, 30 minutes, 1 hour, 1 week, 1 month, 2 months und 3 months thereafter.

Results:

Preliminary results show that IOP was significantly increased 5 minutes after the injection with a concomitant significant drop of OPP and ocular perfusion, respectively. After 1 hour, IOP, OPP as well as the LSFG-derived parameters of ocular perfusion returned to pre-interventional baseline levels.

Conclusions:

To our knowledge, the present report is the first to assess the short- and long-term effects of intravitreal aflibercept on ocular circulation. Our preliminary results show that LSFG represents a viable method for the monitoring of short-term alterations in ocular hemodynamics caused by intravitreal anti-VEGF therapy. A comprehensive analysis of the long-term effects of aflibercept on ocular perfusion will be presented.

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