Efficacy of Injection Interval Shortening in Neovascular Age-related Macular Degeneration with Limited Response to Bimonthly Aflibercept

Purpose: To investigate the effectiveness of shortening the injection interval to < 2 months in neovascular age-related macular degeneration (AMD) with limited response to bimonthly aflibercept injections.Methods: We performed a retrospective analysis of medical records for neovascular AMD patients who received aflibercept injections with < 2 month intervals (shortened injection) because of limited response to bimonthly injections. The best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were compared before and after shortened injections. The incidence of complete resolution of retinal edema was also analyzed.Results: A total of 28 patients were included, with a mean duration between diagnosis and shortened injection of 43.0 ± 20.5 months. The interval of the first shortened injection was 5 weeks in 8 eyes and 6 weeks in 20 eyes. BCVA changed from mean logarithm of minimal angle of resolution of 0.37 ± 0.21 to 0.32 ± 0.20 after shortening (p = 0.075). The mean CRT reduced significantly from 389.3 ± 73.7 μm to 242.1 ± 91.9 μm after shortening (p < 0.001). Retinal fluids resolved completely in 11 (39.3%) eyes after a single shortened injection, and in 15 (53.6%) eyes after two or more shortened injections.Conclusions: Shortening the injection interval to < 2 months had good anatomical efficacy in neovascular AMD with limited response to bimonthly aflibercept injections. However, the efficacy for improvement in visual acuity was limited. Further studies are required to investigate the long-term outcomes.