<?xml version="1.0" encoding="UTF-8"?>
<article article-type="research-article" dtd-version="1.3" xml:lang="en">
  <front>
    <journal-meta>
      <journal-title-group>
        <journal-title>Czech and Slovak Ophthalmology</journal-title>
      </journal-title-group>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">374</article-id>
      <article-id pub-id-type="doi">10.31348/2025/28</article-id>
      <article-categories>
        <subj-group>
          <subject>Original article</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Evaluation of Morphological Changes in the Retina Using OCTA in Patients with Diabetic Macular Edema Treated with anti-VEGF Using ImageJ Software</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Beran</surname>
            <given-names>David</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0116-589X</contrib-id>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Hejsek</surname>
            <given-names>Libor</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9973-8969</contrib-id>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Studnička</surname>
            <given-names>Jan</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-9911-4379</contrib-id>
        </contrib>
      </contrib-group>
      <pub-date date-type="pub" publication-format="electronic">
        <day>6</day>
        <month>6</month>
        <year>2025</year>
      </pub-date>
      <issue>1</issue>
      <elocation-id>3</elocation-id>
      <abstract>
        <p>Aim: To evaluate changes in the vascular density of the deep and superficial capillary plexus of the retina, the area of the foveal avascular zone, central retinal thickness, and best corrected visual acuity in patients with diabetic macular edema treated with anti-VEGF agents. Material and Methods: In a prospective study at the Ophthalmology Clinic of FNHK, we evaluated a group of 41 eyes of 30 patients (19 men and 11 women) with diabetic macular edema treated with Lucentis or Eylea. The average age of the patients was 61.7 ±11.3 years. Average initial visual acuity was 64.4 ±9.1 letters on ETDRS optotypes. During the one-year follow-up period we monitored the density of the deep and superficial retinal capillary plexus using OCTA. We evaluated OCTA scans with the ImageJ program at 3, 6, 9, and 12 months. Additionally, the area of the foveal avascular zone, central retinal thickness, and best-corrected visual acuity were measured. Results: During the one-year follow-up period there was a statistically significant change in both retinal capillary plexuses, with the density of the deep capillary plexus increasing (p &lt; 0.0001) and the superficial capillary plexus decreasing (p = 0.0073). The area of the foveal avascular zone decreased from an initial average value of 0.29 ±0.14 mm² to 0.24 ± 0.07 mm² (p = 0.0406). Average central retinal thickness decreased from 434.1 ±96.2 µm to 322.2 ±90.8 µm (p = 0.0001). Best corrected visual acuity improved by 7.3 letters on ETDRS optotypes over the year (p &lt; 0.0001). Conclusion: Treatment with the aforementioned anti-VEGF agents significantly reduces central retinal thickness and improves visual acuity in patients. It affects the density of the retinal capillary plexuses and the area of the foveal avascular zone. The results of the impact of anti-VEGF agents on macular perfusion vary considerably in the available meta-analyses. The design of the study, the approach to assessing the density of the retinal capillary plexuses, the number and characteristics of patients (including inclusion and exclusion criteria), the duration of the follow-up period, and the specific anti-VEGF agents used are all influential factors.</p>
      </abstract>
      <kwd-group>
        <kwd>diabetic macular edema</kwd>
        <kwd>anti-VEGF</kwd>
        <kwd>optical coherence tomography angiography</kwd>
        <kwd>ImageJ</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <back>
    <ref-list>
      <title>References</title>
      <ref id="R200">
        <mixed-citation>Coscas F, Sellam A, Glacet-Bernard A, et al. Normative Data for Vascular Density in Superficial and Deep Capillary Plexuses of Healthy Adults Assessed by Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci. 2016;57(9):OCT- 211-OCT223</mixed-citation>
      </ref>
      <ref id="R201">
        <mixed-citation>Braham IZ, Kaouel H, Boukari M, et al. Optical coherence tomography angiography analysis of microvascular abnormalities and vessel density in treatment-naïve eyes with diabetic macular edema. BMC Ophthalmol. 2022 Nov 3;22(1):418</mixed-citation>
      </ref>
      <ref id="R202">
        <mixed-citation>Studnička J. Aflibercept v léčbě diabetického makulárního edému [Aflibercept in the Diabetic Macular Edema Treatment]. Cesk Slov Oftalmol. 2015;7:243-246. Czech.</mixed-citation>
      </ref>
      <ref id="R203">
        <mixed-citation>Stino H, Birner K, Hinterhuber L, et al. Influence of OCT biomarkers on microperimetry intra- and interdevice repeatability in diabetic macular edema. Sci Rep. 2024 Oct 7;14(1):23342</mixed-citation>
      </ref>
      <ref id="R204">
        <mixed-citation>Scholl S, Kirchhof J, Augustin AJ. Pathophysiology of macular edema. Ophthalmologica 2010;224:8-15.</mixed-citation>
      </ref>
      <ref id="R205">
        <mixed-citation>Sosna T, Švancarová R, Netuková M, Studnička J. Současný pohled na diabetický makulární edém [Current Overview of Diabetic Macular Edema]. Cesk Slov Oftalmol. 2012;68:91-97. Czech.</mixed-citation>
      </ref>
      <ref id="R206">
        <mixed-citation>Li YF, Ren Q, Sun CH, et al. Efficacy and mechanism of anti-vascular endothelial growth factor drugs for diabetic macular edema patients. World J Diabetes. 2022 Jul 15;13(7):532-542.</mixed-citation>
      </ref>
      <ref id="R207">
        <mixed-citation>Lazăr AS, Stanca HT, Tăbăcaru B, Danielescu C, Munteanu M, Stanca S. Quantitative Parameters Relevant for Diabetic Macular Edema Evaluation by Optical Coherence Tomography Angiography. Medicina (Kaunas). 2023 Jun 10;59(6):1120.</mixed-citation>
      </ref>
      <ref id="R208">
        <mixed-citation>Hsieh YT, Alam MN, Le D, et al. OCT Angiography Biomarkers for Predicting Visual Outcomes after Ranibizumab Treatment for Diabetic Macular Edema. Ophthalmol Retina. 2019 Oct;3(10):826-834.</mixed-citation>
      </ref>
      <ref id="R209">
        <mixed-citation>Golshani C, Conti TF, Conti FF, et al. Diabetic Macular Edema Treated With Intravitreal Aflibercept Injection After Treatment With Other Anti-VEGF Agents (SWAP-TWO Study)-12-Month Analysis. J Vitreoretin Dis. 2020;4(5):364-371.</mixed-citation>
      </ref>
      <ref id="R210">
        <mixed-citation>Statler B, Conti TF, Conti FF, et al. Twenty-Four-Month OCTA Assessment in Diabetic Patients Undergoing Fixed-Interval Intravitreal Aflibercept Therapy. Ophthalmic Surg Lasers Imaging Retina. 2020;51(8):448-455.</mixed-citation>
      </ref>
      <ref id="R211">
        <mixed-citation>Tolentino MJ, Miller JW, Gragoudas ES, et al. Intravitreous injections of vascular endothelial growth factor produce retinal ischemia and microangiopathy in an adult primate. Ophthalmology. 1996;103(11):1820-1828.</mixed-citation>
      </ref>
      <ref id="R212">
        <mixed-citation>Dastiridou A, Karathanou K, Riga P, et al. OCT Angiography Study of the Macula in Patients with Diabetic Macular Edema Treated with Intravitreal Aflibercept. Ocul Immunol Inflamm. 2021;29(5):926-931.</mixed-citation>
      </ref>
      <ref id="R213">
        <mixed-citation>Hofman P, van Blijswijk BC, Gaillard PJ, Vrensen GF, Schlingemann RO. Endothelial cell hypertrophy induced by vascular endothelial growth factor in the retina: new insights into the pathogenesis of capillary nonperfusion. Arch Ophthalmol. 2001;119(6):861-866.</mixed-citation>
      </ref>
      <ref id="R214">
        <mixed-citation>Kurt MM, Çekiç O, Akpolat Ç, Elçioglu M. Effects of intravitreal ranibizumab and bevacizumab on the retinal vessel size in diabetic macular edema. Retina. 2018;38(6):1120-1126.</mixed-citation>
      </ref>
      <ref id="R215">
        <mixed-citation>Benjamin LE, Hemo I, Keshet E. A plasticity window for blood vessel remodelling is defined by pericyte coverage of the preformed endothelial network and is regulated by PDGF-B and VEGF. Development. 1998;125(9):1591-1598.</mixed-citation>
      </ref>
      <ref id="R216">
        <mixed-citation>Stitt AW, Gardiner TA, Archer DB. Histological and ultrastructural investigation of retinal microaneurysm development in diabetic patients. Br J Ophthalmol. 1995;79(4):362-367.</mixed-citation>
      </ref>
      <ref id="R217">
        <mixed-citation>Elnahry AG, Elnahry GA. Optical Coherence Tomography Angiography of Macular Perfusion Changes after Anti-VEGF Therapy for Diabetic Macular Edema: A Systematic Review. J Diabetes Res. 2021;2021:6634637.</mixed-citation>
      </ref>
    </ref-list>
  </back>
</article>
