One-year results of intravitreal aflibercept injections for neovascular age-related macular degeneration using a treat and extend regimen

Abstract

Purpose: To evaluate the therapeutic effect of intravitreal aflibercept injections for neovascular age-related macular degeneration (nAMD) using a treat and extend regimen.

Methods: Thirty-one eyes of 31 nAMD patients, with a mean age of 73.5 (range, 55-88), were treated with 2 mg aflibercept injection monthly for at least 3 months. Monthly injections continued until no retinal exudative changes (i.e. new subretinal hemorrhage and subretinal and/or intraretinal fluid) were observed by optical coherence tomography. When no retinal exudative changes were seen, the interval to the next injection was extended by 2 weeks, up to a maximum of 12 weeks. If signs of exudation recurred, this interval was shortened by 2 weeks. The main outcome measures were 1) changes in best corrected visual acuity (BCVA), central retinal thickness (CRT), and retinal exudation, 2) annual number of injections and 3) the final interval between injections.

Results: The mean BCVA (logarithm of the minimal angle of resolution, log MAR) improved significantly from 0.37 ± 0.36 at baseline to 0.20 ± 0.27 at 1 year (p = 0.0002, paired t-test). BCVAs improved by more than 0.3 logMAR units in 7 eyes (22.6%) and were unchanged in 23 eyes (74.2%). The mean CRT decreased significantly from 329.2 ± 116.8 μm at baseline to 197.6 ± 54.4 μm at 1 year, (p < 0.0001, paired t - test). Retinal exudative changes had resolved completely in 26 eyes (83.9%) at 1 year. The mean number of injections was 8.2 ± 1.7 in a year. The mean interval between injections at 1 year was 9.3 ± 3.4 weeks.

Conclusions: The use of a treat and extend regimen for intravitreal aflibercept injections in nAMD was effective in improving BCVA, CRT, and retinal exudation at 1 year. The mean number of injections and the mean interval between them was very variable between cases.