Subfoveal Choroidal Thickness during Aflibercept Therapy for Neovascular Age-Related Macular Degeneration

Purpose: To investigate changes in subfoveal choroidal thickness after intravitreal aflibercept injections (IAIs) for neovascular age-related macular degeneration (AMD) at 12 months. Design: Retrospective, consecutive, interventional case series. Participants: One hundred forty-four patients with treatment-naive neovascular AMD examined at 3 university hospitals. Methods: After a loading phase of 3 monthly 2.0-mg IAIs, the patients were injected bimonthly with additional rescue injections performed for worsening. Subfoveal choroidal thickness in IAI-treated eyes was evaluated using enhanced depth imaging optical coherence tomography (OCT) or swept-source OCT. Main Outcome Measures: Changes in subfoveal choroidal thickness over a 12-month period. Results: Of the 144 treated eyes, 58 (40.3%) had typical neovascular AMD and 86 (59.7%) had polypoidal choroidal vasculopathy (PCV). The mean subfoveal choroidal thickness of treated eyes decreased from 268.1 +/- 101.3 mm at baseline to 233.0 +/- 99.7 mm at 3 months and remained unchanged at 232.4 +/- 99.6 mm at 12 months (percentage decrease, 13.3% at 12 months compared with baseline; P < 0.0001), although there was some fluctuation in between treatments. This decrease in subfoveal choroidal thickness was associated significantly with gain in visual acuity for PCV eyes (P = 0.0087; R = 0.28), but not for eyes with typical neovascular AMD (P = 0.17; R = 0.18). Eyes without persistent or recurrent retinal fluid after the loading phase showed greater decrease in subfoveal choroidal thickness compared with those with persistent or recurrent retinal fluid, in both typical neovascular AMD (P = 0.042) and PCV (P = 0.038) eyes. Conclusions: Subfoveal choroidal thickness decreased over 12 months with IAI therapy in eyes with neovascular AMD. Changes in subfoveal choroidal thickness after IAIs seem to be related to visual and anatomic outcomes. (C) 2016 by the American Academy of Ophthalmology.