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

Hidetaka Matsumoto; Masahiro Morimoto; Kensuke Mimura; Arisa Ito; Hideo Akiyama

doi:10.1016/j.oret.2017.09.002

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

Ophthalmol Retina. 2018 May;2(5):462-468. doi: 10.1016/j.oret.2017.09.002. Epub 2017 Nov 13.

Authors

Hidetaka Matsumoto¹, Masahiro Morimoto², Kensuke Mimura², Arisa Ito², Hideo Akiyama²

Affiliations

¹ Department of Ophthalmology, Gunma University, School of Medicine, Maebashi, Japan. Electronic address: hide-m@gunma-u.ac.jp.
² Department of Ophthalmology, Gunma University, School of Medicine, Maebashi, Japan.

PMID: 31047326
DOI: 10.1016/j.oret.2017.09.002

Abstract

Purpose: To evaluate the effects of intravitreal injection of aflibercept using a treat-and-extend dosing regimen on treatment-naïve neovascular age-related macular degeneration (AMD) and the development of macular atrophy.

Design: Retrospective, interventional case series.

Participants: Eyes (n = 137) with treatment-naïve 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.