Treat-and-Extend Regimen with Aflibercept for Neovascular Age-Related Macular Degeneration Efficacy and Macular Atrophy Development

Purpose: To evaluate the effects of intravitreal injection of aflibercept using a treat-and-extend dosing regimen on treatment-naive neovascular age-related macular degeneration (AMD) and the development of macular atrophy. Design: Retrospective, interventional case series. Participants: Eyes (n = 137) with treatment-naive neovascular AMD, including 18 eyes with typical AMD with classic choroidal neovascularization (CNV), 44 eyes with typical AMD with occult CNV, 58 eyes with polypoidal choroidal vasculopathy, and 17 eyes with retinal angiomatous proliferation (RAP). Methods: Clinical records of eyes with neovascular AMD that underwent 3 consecutive monthly intravitreal injections of aflibercept followed by a treat-and-extend dosing regimen were reviewed, and the corresponding imaging studies were analyzed. Main Outcome Measures: Changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), and the extent of macular atrophy in the macular area during a 2-year follow-up period. Results: In all subtypes after 1 and 2 years, CMT and CCT were reduced significantly, whereas macular atrophy showed significant enlargement. At baseline, the extent of macular atrophy was greater in RAP than other subtypes; after 2 years, the macular atrophy enlargement was also greatest in RAP and correlated negatively with CCT (rs = -0.72; P < 0.01). Best-corrected visual acuity showed significant improvement after 1 and 2 years in all subtypes other than RAP. In RAP, BCVA was improved significantly after 1 year, but the magnitude of this improvement lost statistical significance after 2 years. Conclusions: Treat-and-extend with intravitreal aflibercept may be effective for improving BCVA and ameliorating exudative changes in neovascular AMD. However in RAP, choroidal thinning during the treatment regimen may accelerate enlargement of macular atrophy, thereby diminishing the improvement in BCVA after 2 years. (C) 2017 by the American Academy of Ophthalmology