INTRAVITREAL AFLIBERCEPT IN THE TREATMENT OF NAIVE NEOVASCULAR MEMBRANES IN AGE-RELATED MACULAR DEGENERATION: SHORT TERM EXPERIENCE IN CLINICAL PRACTICE

Abstract

Purpose: To evaluate the short term outcome of intravitreal aflibercept as first-line therapy in the treatment of naïve choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).

Methods: Retrospective, non comparative case series. Best corrected ETDRS visual acuity (VA), OCT central macular thickness (CMT) and lesion size and type analysis with fluorescein angiography were recorded at baseline, 3 and 6 months. We administered three monthly injections and a single additional injection after at least one month in case persistence or recurrence were seen with clinical and OCT examination.

Results: 100 eyes of 96 patients with a mean age of 78.3 years (SD:7.3) were enrolled, in whom classic (n.31) or occult (n.58) CNV was detected, while 11 eyes had retinal angiomatous proliferation (RAP); 65 lesions were subfoveal and 35 extra- or juxtafoveal.<br /> Overall, mean baseline VA non-significantly improved from 0.52 logMAR at baseline to 0.49 logMAR at 3-months (p=0.138), and returned to baseline value (0.52 logMAR) at 6 months (p=0.982). Mean central macular thickness (CMT) decreased from 311 μm at baseline to 248 μm at 3-months follow-up and 261 μm at 6-months visit (P<0.001 for both times).<br /> Eyes with VA 0.5 logMAR or worse (n.54) gained -0.07 logMAR at 3 months (p=0.003) and -0.047 logMAR at 6 months (p=0.191). Eyes with VA better than 0.5 logMAR (n.46) non-significantly worsened by 0.026 logMAR at 3 month (p=0.308) and 0.054 logMAR at 0.6 months (p=0.166), and did significantly worse than those with better VA (p=0.020). Mean VA did not vary by lesion type (p=0.956) and location (p=0.182).<br /> There were 5 eyes with persistence at 3 months and 15 with recurrence at 5 months.

Conclusions: Intravitreal aflibercept treatment of patients with neovascular AMD and a variety of lesions was effective in maintaining baseline VA and in reducing CMT up to 6 months of follow-up. Standard bimonthly treatment may be advisable for patients with higher visual acuity to try to maintain or improve vision.