Purpose:  To evaluate the effect of intravitreal Aflibercept injection on wet AMD both functionally and anatomically after loading doses. The secondary aim is to evaluate the effect of risk factors including (gender, age, smoking, hypertension, and diabetes meatus) on the patient’s response. Study Design:  Interventional case series. Place and Duration of Study:  Al-Haitham Eyes Teaching Hospital in Baghdad, Iraq, from November 2021 and September 2022. Methods:  Fifty eyes of 47 patients with treatment naïve wet AMD were selected through convenient sampling. Data were collected for age, gender, smoking, and chronic disease. Clinical examination, best corrected visual acuity (BCVA), optical coherence tomography angiography, and spectral domain optical coherence tomography SD-OCT were performed at baseline and then at 16 weeks, after three one-monthly injections of Aflibercept 2 mg/ 0.05 ml intravitreally. Results:  Mean age was 68.23 ± 8.5 years. Mean difference in BCVA was 0.37 ± 0.03 (P = 0.000) and mean difference in central macular thickness was 105.72 ± 45.05 (P value < .0000) at 16 weeks. CNV was associated with intra-retinal fluid in 52% of cases, subretinal fluid in 72%, pigment epithelial detachment in 20%, intraretinal hemorrhage in 6% and subretinal hemorrhage in 4%. Studying associations between the responses of Aflibercept with the general features of the patients as age, gender, chronic diseases and smoking status, revealed no statistically significant difference. Conclusion:  This study demonstrates that aflibercept is effective for the treatment of patients with wet AMD both functionally and anatomically after the loading doses. The presence of intraretinal fluid at presentation had a negative effect on the vision.

Age-related macular degeneration (AMD) is a progressive degenerative eye disorder that primarily affects individuals over 50. It causes gradual loss of central vision and can lead to irreversible severe visual loss if left untreated. AMD is a leading cause of blindness in the developed world. This study aimed to investigate the effects of a loading dosage of intravitreal Aflibercept on functional and morphological responses in neovascular AMD, considering demographic characteristics and the link between AMD-related retinal symptoms at presentations. A prospective interventional study was conducted from November 2021 to September 2022 on a sample of Iraqi patients with neovascular AMD who had active choroidal neovascularization (CNV) lesions confirmed by OCT-A and received intravitreal Aflibercept 2mg injection as initial therapy (3 loading doses). Best-corrected visual acuity (BCVA) was used to measure functional responses, and central macular thickness (CMT) and maximum area of the retinal thickness (MART) (by SD-OCT) were used to measure morphological responses. The study included 48 patients (57 eyes) with active neovascular AMD. The mean difference of BCVA in log MAR (0.2 ± 0.7) significantly improved from 1.3±0.7 at baseline to 1.1±0.8 after loading Aflibercept (P=0.034). The mean difference in CMT 113.6 ± 125.9 was statistically significant (P<0.0001). Also, the mean change in MART significantly decreased from 444.2 ± 127.1 µm at baseline to 348.7±74.5 µm (p < 0.0001) after loading Aflibercept. This study demonstrated that Aflibercept is a functionally and anatomically successful treatment for neovascular AMD.