Choriocapillaris Vascular Density Changes: Healthy vs. Advanced Exudative Age-Related Macular Degeneration Previously Treated with Multiple Anti-VEGF Intravitreal Injections

Maria Cristina Savastano; Clara Rizzo; Gloria Gambini; Alfonso Savastano; Benedetto Falsini; Daniela Bacherini; Carmela Grazia Caputo; Raphael Kilian; Francesco Faraldi; Umberto De Vico; Stanislao Rizzo

doi:10.3390/diagnostics11111958

Choriocapillaris Vascular Density Changes: Healthy vs. Advanced Exudative Age-Related Macular Degeneration Previously Treated with Multiple Anti-VEGF Intravitreal Injections

Diagnostics (Basel). 2021 Oct 22;11(11):1958. doi: 10.3390/diagnostics11111958.

Authors

Maria Cristina Savastano^{1

2}, Clara Rizzo³, Gloria Gambini^{1

2}, Alfonso Savastano^{1

2}, Benedetto Falsini^{1

2}, Daniela Bacherini⁴, Carmela Grazia Caputo^{1

2}, Raphael Kilian⁵, Francesco Faraldi⁶, Umberto De Vico¹, Stanislao Rizzo^{1

2

7}

Affiliations

¹ Unit of Ophthalmology, Fondazione Policlinico A. Gemelli, IRCCS, 00191 Rome, Italy.
² Unit of Ophthalmology, Università Cattolica Sacro Cuore, 00168 Rome, Italy.
³ Ophthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy.
⁴ Department of Surgery and Translational Medicine, AOU Careggi, University of Florence, 50139 Florence, Italy.
⁵ Ophthalmology Unit, University of Verona, 37134 Verona, Italy.
⁶ Torino, Eye Clinic, ASL Torino 5, 10024 Turin, Italy.
⁷ Consiglio Nazionale della Ricerca (CNR), Istituto di Neuroscienze, 56124 Pisa, Italy.

Abstract

Purpose: To assess choriocapillaris vascular density (VD) in healthy and advanced exudative age-related macular degeneration (ae-AMD) patients by new full-range optical coherence tomography angiography (OCT-A).

Method: In this observational, cross-sectional study, 21 healthy and 21 ae-AMD eyes, already treated with anti-VEGF, were enrolled. Angio-View retina patterns centered on fovea (6.4 × 6.4 mm) were acquired for all participants using Solix full-range OCT (Optovue Inc., Freemont, CA, USA). The main outcome was to compare choriocapillaris VD between healthy and ae-AMD eyes. Automated measurements of whole image choriocapillaris VD (%) and fovea grid-based (%) were collected for the analysis. Angio-View patterns were used to assess the flow area (mm²) of macular neovascularization (MNV) by contour flow measure algorithm. Best-corrected visual acuity (BCVA) of both groups was also used for the statistical analysis.

Results: The mean age was 60.9 (±8.3) in healthy and 73.33 (±15.05) in ae-AMD eyes. The mean BCVA (ETDRS letters) was 98.47 (±1.50) in healthy and 7.04 (±5.96) in ae-AMD eyes. The Mann-Whitney test comparing choriocapillaries VD for whole and fovea healthy and ae-AMD eyes showed statistical significance (p < 0.0001 (t = 4.91; df = 40) and p < 0.0001 (t = 6.84; df = 40), respectively). Regarding, the correlation between MNV and VD of choriocapillaries, neither whole nor fovea areas were statistically significant (F = 0.38 (R² = 0.01) and 1.68 (R² = 0.08), respectively).

Conclusions: Choriocapillaris VD showed a statistically significant reduction in comparison to healthy eyes in ae-AMD eyes. Choriocapillaris impairment can be seen in the early phase of MNV pathogenesis.

Keywords: OCT angiography; advanced exudative AMD; age-related macular degeneration; biomarkers; innovative biotechnologies; macular neovascularization; personalized medicine.