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 (HDA) 8.0 mg, focusing on anatomical and functional changes, as well as the feasibility of extending treatment intervals in a clinical practice setting.

Design

Retrospective, noncomparative cohort study.

Subjects

Two hundred nineteen eyes from 184 patients with nAMD who received ≥3 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 Outcome Measures

The primary outcome was the proportion of eyes able to sustain an 8 ± 1-week or longer treatment interval without anatomical deterioration. The 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 3 injections, 206 eyes (94.1%) received a fourth HDA, and 70 eyes (31.9%) received a fifth HDA. One hundred two eyes (46.6%) of the total cohort with an interval shorter than 8 weeks after 3 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%–41.1%, P = 0.006) and intraretinal fluid (53.9%–39.3%, P = 0.002). Among previously treated eyes, the mean preswitch treatment interval was 5.8 ± 2.5 weeks and increased to 7.4 ± 2.2 weeks after the 3 initial injections (P < 0.0001).

Conclusions

High-dose aflibercept 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 ≥8 weeks due to persistent macular fluid. These findings suggest that HDA maintains functional stability while improving anatomic outcomes, though challenges in managing chronic nAMD in a clinical-practice setting may limit the ability to extend treatment intervals.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.