Longitudinal panretinal microaneurysm dynamics on ultra-widefield fluorescein angiography in eyes treated with intravitreal aflibercept for proliferative diabetic retinopathy in the recovery study.

Background/aims: Quantifying microaneurysms (MAs) turnover may be an objective measure for therapeutic response in diabetic retinopathy. This study assesses changes in MA counts on ultra-widefield fluorescein angiography (UWFA) in subjects undergoing treatment with intravitreal aflibercept injection (IAI) for proliferative diabetic retinopathy (PDR) in the Intravit re al Afliber c ept for Retinal N o n-Perfusion in Proliferati v e Diab e tic R etinopath y (RECOVERY) study using an automated MA detection platform.
Methods: RECOVERY is a prospective study that enrolled 40 subjects with PDR randomised 1:1 to receive 2 mg IAI every 4 weeks(q4wk) or every 12 weeks (q12wk). UWFA images were obtained at baseline, 6 months and 1 year. Images were analysed using an automated segmentation platform to detect and quantify MAs. Zones 1, 2 and 3 correspond to the macula, mid-periphery and far-periphery, respectively.
Results: The q4wk cohort demonstrated a significant decline in MAs in all zones and panretinally at baseline versus month 6, baseline versus year 1, and month 6 versus year 1 (-20.0% to -61.8%; all p<0.001). In the q12wk cohort, baseline versus month 6 showed a significant decline panretinally (mean: -34.2%; p<0.001) and in zone 3 (mean -44.18%; p<0.001). Addiitonally, baseline to year 1 in the q12wk group demonstrated significant decline panretinally (mean: -47.7%; p<0.001) and in zone 3 (mean: -59.8%; p<0.001). All zones demonstrated significantly decline from month 6 to year 1 in the q12wk group.
Conclusion: Therapy with IAI demonstrates significantly reduced panretinal MA counts in PDR at 1 year in both treatment groups. The use of automated platforms to detect and quantify MAs may provide a novel imaging marker for evaluating disease activity and therapeutic impact.
Trial Registration Number: NCT02863354.
Competing Interests: Competing interests: AB, research support—Genentech, Allergan; consulting—Genentech; CCW, research support—Adverum, Allergan, Apellis, Clearside, EyePoint, Genentech/Roch, Neurotech, Novartis, Opthea, Regeneron, Regenxbio, Samsung, Santen; consulting—Adverum, Alimera Sciences, Allegro, Allergan, Apellis, Bayer, Clearside, DORC, EyePoint, Genentech/Roche, Kodiak, Notal Vision, Novartis, ONL Therapeutics, PolyPhotonix, RecensMedical, Regeneron, Regenxbio, Santen, Takeda; SS, research support—Regeneron, Allergan, Gilead; consulting: Bausch and Lomb, Santen; patent—Leica; SVRS, research support—Carl Zeiss Meditec, consulting—Optos, CenterVue, Heidelberg Engineering, Roche/Genentech, Novartis, Allergan, Amgen, Bayer; research instruments—Carl Zeiss Meditec, Nidek, Topcon; JPE, research support—Aerpio, Alcon, Thrombogenics, Regeneron, Genentech, Novartis; consulting—Aerpio, Alcon, Allegro, Allergan, Genentech/Roche, Novartis, Thrombogenics, Leica, Zeiss, Regeneron, Santen; patent—Leica; MI, consultant: Boehringer Ingelheim, Thrombogenics, Quark, Omeros, Allergan, Amgen, Astellas, Alimera; research support—Novartis, Genentech, Clearside, Biogen. KET, HJY, MN MH, JR, no competing interests.
(© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)