Can Anti-VEGF Reverse Ischemia?

The image above is a 73 year old diagnosed with a recent retina vein occlusion with significant peripheral and macular ischemia as seen on the fluorescein angiogram.

Diabetic retinopathy (DR) is a common complication of diabetes mellitus. Imaging techniques such as the gold standard of fluorescein angiography (FA) and the recent advent of optical coherence tomography angiography (OCTA) have allowed for detailed visualization of the microvasculature to assess and quantify macular perfusion. The development of ultra-widefield fluorescein angiography (UWFA) has allowed clinicians to examine ischemia within the periphery. As our imaging and diagnostic methods continue to be refined, it is important to understand how to best utilize these technologies to characterize disease severity and determine how it guides treatment and prognosis. With the increasing use of anti-vascular endothelial growth factor agents for treatment of DR, we can characterize the changes in perfusion on the microvascular level. The focus of this review is to summarize and identify the changes in both macular and peripheral perfusion with anti-VEGF treatment for patients with diabetic retinopathy utilizing FA, UWFA, and OCTA. There remains a need for more prospective, longer-term clinical trials with controls to better understand the characterization of the retinal microvasculature using these imaging techniques. In clinical practice, physicians likely will need to utilize a multimodal imaging approach to appropriately characterize the degree and progression of ischemia in DR.

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