Initial Functional and Anatomical Outcomes of High-Dose Aflibercept 8 mg in Exudative Neovascular Age-Related Macular Degeneration.

Abstract

Purpose: To evaluate the short-term outcomes of patients with exudative neovascular age-related macular degeneration (nAMD) treated with high-dose aflibercept 8.0 mg (HDA), focusing on anatomical and functional changes, as well as the feasibility of extending treatment intervals in real-world clinical practice.

Design: Retrospective, noncomparative cohort study.

Subjects: 219 eyes from 184 patients with nAMD who received at least three HDAs between August 2023 and October 2024.

Methods: Patients included in this study were either treatment-naïve or had been previously treated with other anti-VEGF agents. Clinical outcomes, including best-corrected visual acuity (BCVA) and macular OCT parameters, were evaluated at baseline and after each HDA.

Main outcomes: The primary outcome was the proportion of eyes able to sustain an 8 ± 1 week or longer treatment interval without anatomical deterioration. Secondary outcomes included anatomical and functional changes.

Results: The average follow-up time was 22.9 ± 4.9 weeks. 209 eyes (95.4%) were previously treated, and 10 eyes (4.6%) were treatment-naïve. After the first three injections, 206 eyes (94.1%) received a fourth HDA and 70 eyes (31.9%) received a fifth HDA. 102 eyes (46.6%) of the total cohort with an interval shorter than 8 weeks after three initial injections had persistent macular fluid. 24 eyes (11.0%) were switched to another anti-VEGF agent. Overall, the mean BCVA was 61.9 ± 21.7 ETDRS letters at baseline and 61.7 ± 22.6 at the final visit, with no statistically significant difference observed (p = 0.934). Central subfield thickness and pigment epithelial detachment height remained stable. Significant reductions were observed in subretinal (54.3% to 41.1%, p = 0.006) and intraretinal fluid (53.9% to 39.3%, p = 0.002). Among previously treated eyes, the mean pre-switch treatment interval was 5.8 ± 2.5 weeks and increased to 7.4 ± 2.2 weeks after the three initial injections (p < 0.0001).

Conclusions: HDA demonstrated stable BCVA and significant reductions in macular fluid during the follow-up period. A considerable proportion of patients were unable to extend treatment intervals to at least 8-weeks due to persistent macular fluid. These findings suggest that HDA maintains functional stability while improving anatomic outcomes, though real-world challenges in managing chronic nAMD may limit the ability to extend treatment intervals.