Three-year outcome of aflibercept treatment for Japanese patients with neovascular age-related macular degeneration

Abstract

Background To evaluate the three-year outcome after intravitreal aflibercept injection (IAI) for neovascular age-related macular degeneration (nAMD). Methods Forty-nine treatment-naïve nAMD patients (50 eyes) were enrolled in this prospective study. The eyes received IAI at two-month intervals in the first year. The treatment regimen was changed to IAI based on a treat-and-extend approach in the second and third years. Results Twenty-nine eyes of 28 patients were successfully followed up over 36 months. The nAMD subtypes included 15 eyes with typical AMD and 14 eyes with polypoidal choroidal vasculopathy. The number of IAIs performed over the 3 years was 17.2 ± 3.1 (mean ± standard deviation). The mean logMAR, which was 0.42 at baseline, improved to 0.19 ( P = 0.001) at 12 months, and 0.26 ( P = 0.049) at 36 months. The central retinal thickness (CRT) was 329 ± 120 μm at baseline, 151 ± 38 μm ( P < 0.001) at 12 months, and 143 ± 61 μm ( P < 0.001) at 36 months. The mean subfoveal choroidal thickness (SFCT) was 288 ± 97 μm at baseline, 243 ± 82 μm ( P < 0.001) at 12 months, and 208 ± 63 μm ( P < 0.01) at 36 months. The changes in logMAR, CRT, and SFCT over the study period did not differ between typical AMD and PCV. Conclusion Long-term aflibercept injection can achieve visual improvement and reduce the thickness of the retina and choroid in nAMD. Morphological improvement of these tissues may not be sufficient to sustain earlier visual improvement over the long-term.

Aflibercept for age-related macular degeneration: 4-year outcomes of a ‘treat-and-extend’ regimen with exit-strategy

“… 21 Another study reported a BCVA gain of 6.6 at 3 years. 22 In general, our data support the T&E protocol with extension of the intervals as soon as disease stability is documented. In summary, our visual acuity data are consistent with expectations in this setting.…”

Changes in complement activation products after anti-VEGF injection for choroidal neovascularization in age-related macular degeneration and pachychoroid disease

“…Thus far, the choroid might become thinner as a result of anti-VEGF treatment during recovery of the choroidal vasculature from the pathologic changes in nAMD. However, we reported that the tendency for the choroid to become thin did not stop during 3 years of anti-VEGF therapy 31 . The VEGF levels after the treatment reportedly decreased below the lower limit of the quantification for about 3 months maximally 32 .…”

Changes in complement activation products after anti-VEGF injection for choroidal neovascularization in age-related macular degeneration and pachychoroid disease

“…30 Thus far, the choroid might become thinner during recovery of the choroidal vasculature from the pathologic changes in nAMD by anti-VEGF treatment. However, we reported that the tendency for the choroid to become thin did not stop during 3 years of anti-VEGF therapy 31 . The VEGF levels after the treatment reportedly decreased below the lower limit of the quanti cation for about 3 months maximally 32 .…”