Background: Diabetic macular edema (DME) is a major cause of vision loss in diabetics
worldwide. Anti-vascular endothelial growth factor (anti-VEGF) agents have become the mainstay
of treatment of vision loss due to DME. Long-term effects of these agents on the macular perfusion
(MP) are a current concern.
Objective: To review recently published studies that evaluated the effect of intravitreal injection of
anti-VEGF agents on the MP of diabetics with DME.
Methods: Different databases were searched including PubMed, Medline, Ovid, Science Direct,
and Google Scholar for relevant studies published between 2010 and 2019. All studies found were
compared regarding methodology and results and included in this review. Some studies relating to
retinal perfusion in general and not strictly MP were also included for comprehensiveness.
Results: Several studies utilizing different anti-VEGF agents were identified. All the large randomized
controlled clinical trials identified utilized primarily fluorescein angiography (FA) and human
graders and found generally no worsening of MP associated with anti-VEGF agents use in diabetic
patients with DME. Some of these studies, however, depended on post-hoc analysis. Several
more recent, but smaller case series, have utilized the relatively new and non-invasive optical coherence
tomography angiography (OCTA) in this evaluation and found more conflicting results.
Conclusion: The large clinical trials recently performed depended mainly on FA in the analysis of
MP changes following injections and generally found no worsening of MP. More recently, smaller
case series have utilized OCTA in this analysis, yielding more conflicting results. Large randomized
controlled trials using OCTA are thus needed.