PO-21 | Evaluating the impact of anti-CGRP monoclonal antibodies on retinal features in migraine patients: a retrospective optical coherence tomography study

Chiara Serafini,¹ Massimo Cesareo,² Alessio Martucci,² Marco Lombardo,² Vittoria Carla D’Agostino,¹ Alessandro Stefani,³ Carlo Nucci,² Nicola Biagio Mercuri,^1,3 Maria Albanese^1,3 | ¹Regional Referral Headache Center, Neurology Unit, Tor Vergata University Hospital, Rome, Italy ²Ophthalmology Unit, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome; ³Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy

Background: Migraine is a disabling neurovascular disorder characterized by recurrent attacks that lead to extracranial and visual involvement. Several studies have investigated the retinal vasculature features in individuals with migraine, but there have been conflicting results. This study aims to evaluate retinal structure in migraine patients before (T0) and after six months of therapy (T1) with anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs), using optical coherence tomography (OCT) imaging.

Methods: A case-control longitudinal study was conducted from January 2021 to December 2023, including 20 eyes from 10 healthy controls (HCs) and 32 eyes from 16 migraine patients treated with anti-CGRP mAbs according to AIFA criteria. Patients underwent OCT angiography (OCT-A) to assess retinal vessel density and spectral-domain OCT (SD-OCT) to measure central retinal thickness, macular structure, and peripapillary retinal nerve fiber layer (pRNFL) thickness. Measurements were performed in both groups at baseline (T0) and after six months (T1) as part of routine clinical care.

Results: All migraineurs exhibited a significant reduction in disease disability at T1, as assessed by clinical parameters. OCT data analysis revealed that individuals with migraine showed a significant increase in temporal RNFL thickness and a reduction in nasal RNFL thickness compared to healthy controls (HCs). No differences in retinal circulation were observed between the groups at baseline. At T1, RNFL thickness remained sustained in the superior-temporal sector, while the percentage vessel density of the superficial capillary plexus and radial peripapillary capillary significantly increased in the nasal perifoveal, inferior-temporal, and hemi-inferior subregions.

Conclusion: Our findings suggest that specific retinal structural changes may precede vascular dysfunction in migraine and can be detected early by combining SD-OCT and OCT-A. Short-term treatment with anti-CGRP mAbs may have neuroprotective effects, potentially preventing permanent ocular damage.