Association of Molar Dose and Early Retinochoroidal Blood Flow Changes After Intravitreal Anti-Vascular Endothelial Growth Factor Therapy.

PURPOSE: The purpose of this study was to evaluate short-term intraocular blood flow changes post-intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection in patients with neovascular age-related macular degeneration (nAMD), compare reductions across 4 agents (brolucizumab, faricimab, aflibercept 2 mg, and aflibercept 8 mg), and examine correlations between each agent's molar dose and the magnitude of 30-minute blood flow change.

METHODS: This retrospective series included 61 eyes with nAMD (15 treated with brolucizumab, 15 with faricimab, 15 with aflibercept 2 mg, and 16 with aflibercept 8 mg). Laser speckle flowgraphy quantified mean blur rate (MBR) at the optic nerve head vessels (ONH MBR-vessel) and choroid (CHOR MBR) before and 30 minutes post-injection. Percent changes (%ONH MBR-vessel, %CHOR MBR) were compared among groups, and correlations with molar dose were assessed.

RESULTS: In the aflibercept 8 mg group, the mean percent changes were -11.2% ± 11.2% for ONH MBR-vessel (P = 0.001) and -13.7% ± 7.5% for CHOR MBR (P < 0.001). Pairwise comparisons showed no significant differences in %ONH MBR-vessel between aflibercept 8 mg and other agents. The reduction in %CHOR MBR was significantly greater with aflibercept 8 mg than with aflibercept 2 mg (P = 0.019). Molar dose was not significantly correlated with %ONH MBR-vessel, whereas %CHOR MBR showed a significant negative association with molar dose (Spearman ρ = -0.395, P = 0.002).

CONCLUSIONS: Aflibercept 8 mg produced a significant 30-minute reduction in ocular blood flow. Choroidal flow reduction was greater than with aflibercept 2 mg and negatively correlated with molar dose, suggesting a concentration-dependent hemodynamic effect.