Quantitative Analysis of Fibrovascular Membrane Traction in Antivascular Endothelial Growth Factor–Associated Crunch Syndrome Using Integrated Ultrawide-Field Imaging and Swept-Source Optical Coherence Tomography

Purpose: To characterize changes in fibrovascular membrane traction following antivascular endothelial growth factor (anti-VEGF) treatment in eyes with proliferative diabetic retinopathy. Methods: Fibrovascular membrane traction was decomposed into anteroposterior, tangential, and bridging vectors and quantitatively assessed using standardized ultrawide-field fundus imaging with navigated swept-source optical coherence tomography (OCT). Results: Five eyes of 5 patients with high-risk proliferative diabetic retinopathy demonstrated progression of fibrovascular membrane traction following intravitreal anti-VEGF injection. Ultrawide-field fundus imaging with navigated swept-source OCT showed increases in anteroposterior traction ranging from 5.3% to 62% and in tangential traction ranging from 3% to 14% compared with pre-injection measurements (follow-up interval, 1–10 weeks). Over a 6-month follow-up period, fibrovascular membrane traction remained stable in 4 eyes, whereas 1 eye developed macula-threatening traction and vision loss requiring vitrectomy. Conclusions: This retrospective series demonstrates dynamic changes in fibrovascular membrane traction following anti-VEGF therapy in proliferative diabetic retinopathy. Quantitative assessment using integrated ultra-widefield imaging and navigated swept-source OCT may provide a useful approach for monitoring tractional changes and informing clinical decision-making regarding fibrovascular membrane management. Larger prospective studies are warranted to validate these findings.