Short-term effects of anti-vascular endothelial growth factor on peripapillary choroid and choriocapillaris in eyes with neovascular age-related macular degeneration

Purpose: To investigate the effects of anti-vascular endothelial growth factor (anti-VEGF) on the peripapillary choroid and choriocapillaris in eyes with neovascular age-related macular degeneration (nAMD). Methods: We included consecutive patients who underwent three monthly intravitreal injections of aflibercept or ranibizumab for nAMD, followed by swept-source optical-coherence tomography angiography (SS-OCTA). Peripapillary choroidal thickness (CT) and vascular density (VD) of the peripapillary choriocapillaris were measured in SS-OCT and OCTA images at baseline and at 1 month after three monthly injections of anti-VEGF. Results: In 68 eyes of 68 patients with nAMD, peripapillary CT decreased from 124.5 ± 69.9 μm to 116.5 ± 68.2 μm (P = 0.003) after three monthly intravitreal injections of anti-VEGF. The mean vascular density (VD) of the peripapillary choriocapillaris also decreased from 73.99 ± 6.33 to 71.82 ± 6.51 (P < 0.001). The change in the peripapillary choriocapillaris VD was significantly affected by baseline peripapillary choriocapillaris VD, baseline peripapillary CT, and type of nAMD (P = 0.004, P = 0.028, P = 0.015, respectively). The baseline VD of the choriocapillaris was lower in non-responders (median, 70.63; 25–75%, 68.12–71.27) than in responders (median, 75.32; 25–75%, 70.09–79.96) (P = 0.032). Conclusion: These results suggest that anti-VEGF injection influences the peripapillary choriocapillaris flow out of exudative lesions, and that its effects depend on the baseline status of the choroid and choriocapillaris.