Evaluation of the Posterior Lens Capsule Using Optical Coherence Tomography in Anti-Angiogenic Therapy

Relevance With the increasing number of patients receiving IV antiangiogenic drugs, there is a growing need to study their effect on the structures of the eye. Anterior segment OCT allows detecting early damage to the posterior lens capsule. The study analyzes the relationship between the number of IVs and the risk of these damages [1, 3]. Antiangiogenic therapy, including IV aflibercept, is the standard of care for neovascular age-related macular degeneration (nAMD). This study examines the possibility of using OCT to assess the risk of damage to the posterior lens capsule and to study the mechanisms of these changes [4, 5]. Objective To assess the likelihood of damage to the posterior lens capsule in patients with a native lens receiving multiple IV aflibercept, using anterior segment OCT. To determine the critical injection threshold after which the risk of damage increases, and to identify predisposing factors. Material and methods The study included 100 patients (14 men, 86 women, mean age 70.57 ± 7.98 years) who received aflibercept IVV for 12 months according to the TREAT&EXTEND (T&E) protocol. Participants were divided into two groups: group 1 (50 patients) - less than 10 IVV; group 2 (49 patients) - 10 or more IVV. OCT of the anterior segment of the eye was performed at the beginning of the study, and then after 3, 6 and 12 months. Structural changes in the posterior lens capsule and their relationship with the number of injections were assessed. Results A significant correlation (r = 0.473; p = 0.001) was found between the number of IVV and the risk of damage to the posterior lens capsule. The probability of injury was low with less than 15 IAVs, but after the 15th injection the risk increased. Three risk groups were identified: low (< 20 IAVs) - < 4%; medium (20-24 IAVs) - 37.5%; high (≥ 25 IAVs) - > 75%. Kaplan-Meier analysis confirmed the dependence of the risk of injury on the total number of injections. ROC analysis showed high accuracy in predicting injury (AUC = 87.3%). Patients with high density of the lens cortex layers had an increased risk of injury. Possible mechanisms include mechanical impact of the needle and changes in the biomechanical properties of the lens with long-term use of antiangiogenic therapy. Conclusion OCT is an effective method for assessing changes in the posterior lens capsule in patients receiving IAV aflibercept. The study showed that the risk of injury increases sharply after the 15th injection. Additional predisposing factors, including lens cortex density and mechanical stress during injections, were also identified. The data obtained can be used to individualize treatment tactics, monitor patients, and develop preventive strategies. Keywords: optical coherence tomography; posterior lens capsule; antiangiogenic therapy; aflibercept; age-related macular degeneration