First Author: A.Ito JAPAN
Co Author(s): H. Matsumoto M. Morimoto K. Mimura H. Akiyama
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To evaluate the efficacy of a treat-and-extend (TAE) regimen with intravitreal injection of aflibercept (IVA) for typical age-related macular degeneration (tAMD).
Intravitreal anti-vascular endothelial growth factor (VEGF) therapy has become a major treatment strategy for exudative AMD. There are many reports on therapeutic outcomes of various regimens with anti-VEGF agents for exudative AMD. However, reports on therapeutic outcomes of TAE with aflibercept for untreated exudative AMD are rare.
We retrospectively studied 62 eyes that had been continuously treated for more than 2 years with a TAE regimen using intravitreal injections of aflibercept for untreated tAMD. Choroidal neovascularization (CNV) classifications were predominantly classic CNV in 17 eyes (27.4%), minimally classic CNV in one eye (1.6%), and occult CNV in 44 eyes (71.0%). The TAE regimen involved three monthly 2 mg IVA in the loading phase. This was followed by prolongation of the injection interval by 2 weeks if no exudative changes were seen or shortening of the injection interval by 2 weeks if exudative changes were seen in the maintenance phase. The maximum injection interval was set at 12 weeks. Best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), number of intravitreal injections, and complications during the 2 years were evaluated.
BCVA significantly improved from 0.36±0.05 LogMAR units (mean±standard error) before treatment to 0.25±0.05 after the loading phase and was maintained at 0.23±0.05 even after 2 years. CMT significantly decreased from 336±20 µm before treatment to 179±10 µm after the loading phase and was maintained at 172±8 µm after 2 years. CCT also significantly decreased from 244±14 µm before treatment to 206±13 µm after the loading phase and was maintained at 200±12 µm after 2 years. The average number of injections was 8.1 and 5.4 in the first and second year, respectively. In the second year, eighteen eyes with classic CNV (predominantly or minimally classic CNV) needed significantly fewer treatments than forty-four eyes with occult CNV (average 4.6 vs 5.7 times). Retinal pigment epithelial tears occurred in two eyes (3.2%), both of which had occult CNV and elevated pigment epithelial detachment. Subfoveal fibrosis was seen in 14 eyes (22.5%), and patients with subfoveal fibrosis had significantly poorer visual acuity after 2 years. Subfoveal fibrosis was significantly common in classic CNV.
A TAE regimen using intravitreal injections of aflibercept for tAMD was effective for improving and maintaining visual acuity and exudative changes for 2 years. Compared with occult CNV, classic CNV was prone to subfoveal fibrosis; however, exudation might be suppressed with fewer treatments.