Abstract
Purpose:
To describe morphological changes in patients with treatment-resistant neovascular age-related macular degeneration (nAMD) receiving intravitreal aflibercept over 2 years.
Methods:
Forty seven patients with treatment resistant nAMD were prospectively evaluated over 96 weeks. Three loading doses of intravitreal aflibercept were administered at 4 week intervals, followed by injections every 8 weeks over 48 weeks (7 injections). Beyond 48 weeks, further injections were administered on a spectral-domain optical coherence tomography (OCT)-guided treat and extend regime to 96 weeks.<br /> Patients underwent OCT at every visit to determine the presence of sub-retinal fluid (SRF), intra-retinal fluid (IRF) and pigment epithelial detachment (PED). Two independent graders measured maximum SRF height, IRF diameter and PED height. Mean change in fluid parameters were compared between baseline and weeks 48 and 96 using paired t tests.
Results:
The mean number of aflibercept injections was 7.9±1.6 between 48 and 96 weeks. SRF was present in 41 patients (87.2%), 28 patients (59.6%) and 15 patients (31.9%) at baseline, 48 weeks and 96 weeks respectively. Mean SRF height was 117.3±70.0µm at baseline, and decreased by 53.2±80.6µm (p<0.001) at 48 weeks and 95.2±72.3µm (p<0.001) at 96 weeks. Among 6 patients without SRF at baseline, 1 patient developed SRF over the follow-up period and this resolved by 96 weeks.<br /> IRF was present in 28 patients (59.6%), 19 patients (40.4%) and 14 patients (29.8%) at baseline, 48 and 96 weeks respectively. Mean IRF diameter at baseline was 531±515.6µm, and decreased by 293.0±585.7µm at 48 weeks (p=0.013) and 343.7±581.0µm at 96 weeks (p=0.004). Among 19 patients without IRF at baseline, 10 patients developed IRF over the follow-up period, which resolved in 6 patients by 96 weeks.<br /> PED was present in 41 patients (87.2%) at baseline and 36 patients (76.6%) at both 48 weeks and 96 weeks. Mean PED height at baseline was 211.1±138.0µm, and decreased by 45.6±71.6µm (p<0.001) at 48 weeks and 54.8±76.9µm (p<0.001) at 96 weeks.
Conclusions:
Intravitreal aflibercept is effective in reducing SRF, IRF and PED in patients with treatment resistant nAMD, and maintaining these improvements over 96 weeks. Aflibercept is effective in achieving reduction in all 3 fluid types with less than monthly administration even in treatment-resistant patients.