Influence of Anti-VEGF Injections on Longitudinal Changes in Vascular Metrics Measured by OCTA in Age Related Macular Degeneration: A Retrospective Real-World Study

Purpose: To investigate the possible influence of repeated anti-VEGF injections on vascular metrics measured by optical coherence tomography angiography (OCTA) in patients with age-related macular degeneration (AMD). Methods: This retrospective longitudinal study included AMD patients with a follow-up time of at least 18 months from 2019 to 2024. Swept-source OCTA was performed on all eyes. Based on whether an eye received injections or not during follow-up, all eyes were divided into two groups (non-injection group only included non-exudative AMD). Vessel density, Vessel skeleton density in the superficial, deep, and retina slab, as well as foveal avascular zone (FAZ) size, circularity and perimetry of Angio 6mm× 6mm were calculated. Change in vascular metrics between baseline and last follow-up were compared between the two groups using t -test or Mann–Whitney U -test. Correlation between change in vascular metrics and visual acuity was investigated by Spearman’s Rank Correlation test. Results: A total of 164 eyes from 107 patients were included. The average follow-up time was 34 months. No statistically significant difference in baseline vascular metrics was detected between the injection group (57 eyes) and non-injection (107 eyes) group. The injection group received 12.56 injections during follow-up. Among all the parameters, only change in FAZ size during follow-up showed a statistically significant difference between the two groups (0.03 vs. 0.02 mm 2 , P =0.043). No correlation was found between change in vascular metrics and change in visual acuity ( P > 0.05). Conclusion: In this retrospective longitudinal study of 164 eyes, repeated intravitreal anti-VEGF injections were associated with no relevant significant changes in OCTA vascular metrics over time.