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Purpose:  To present optical coherence tomography angiography (OCTA) features in patients with diabetic retinopathy (DR) at the baseline and in response to treatment with anti-VEGF intravitreal injections. To investigate the role of OCTA in management of patients with DR.    Methods:  Retrospective case series showing primary outcomes of 3 patients with DR and diabetic macular edema. Patients were injected intravitreally a loading phase of 3 monthly 2.0 mg aflibercept, followed by 2 injections bimonthly (5 injections in total). Before each injection OCTA was performed using 3 mm × 3 mm scans (Optovue, XR Avanti). The obtained scans of the macula were analyzed and compared to the image at the baseline. Best-corrected visual acuity (BCVA) was examined at the baseline and before each injection.    Results:  In the superficial plexus, a rarefaction of capillaries with capillary dropout and nonperfusion areas were present in all eyes. The microaneurysms were good to visualize in 3 mm × 3 mm scans. In deep vascular network, evident microvascular alterations around the small cystoid edema cells were to detect. There were no differences in perfusion density level for the whole macular area in 3 mm × 3 mm scans shown in density maps between injections in all presented cases. After a series of aflibercept intravitreal injections decreased cystic changes were observed. Moreover in all presented cases, the decrease in central retinal thickness that correlated clinically with improvement of visual acuity (BCVA) was observed. All patients achieved a goal of well-controlled diabetes by having a HbA1c level (<8.0%) before each injection.    Conclusions:  OCTA is a dyeless, quick, and noninvasive method which allows to detect ischemic changes in DR and might be a useful tool in observing the progress of the disease and the response to anti-VEGF treatment in clinical practice.

Optical coherence tomography angiography in patients with diabetic retinopathy treated with anti-VEGF intravitreal injections