Visual and anatomical outcomes associated with treat-and-extend administration of intravitreal aflibercept for neovascular age-related macular degeneration

Mohamed Kamel Soliman; Nicolas Tuli; Thomas K Lee; William A Britton; Raman Tuli

doi:10.1186/s40942-021-00326-4

Visual and anatomical outcomes associated with treat-and-extend administration of intravitreal aflibercept for neovascular age-related macular degeneration

Int J Retina Vitreous. 2021 Sep 27;7(1):54. doi: 10.1186/s40942-021-00326-4.

Authors

Mohamed Kamel Soliman^{1

2}, Nicolas Tuli³, Thomas K Lee^{1

4}, William A Britton^{1

4}, Raman Tuli^{5

6

7}

Affiliations

¹ Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada.
² Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt.
³ Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada.
⁴ Retina Center of Ottawa, Ottawa, ON, Canada.
⁵ Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada. rtuli@toh.ca.
⁶ Retina Center of Ottawa, Ottawa, ON, Canada. rtuli@toh.ca.
⁷ The Ottawa Hospital Riverside Campus, University of Ottawa, Ottawa, ON, K1H 7W9, Canada. rtuli@toh.ca.

Abstract

Purpose: To investigate the visual and anatomical outcomes associated with treat-and-extend (TAE) regimen of intravitreal (IVT) aflibercept in eyes with treatment naïve neovascular age-related macular degeneration (nvAMD).

Methods: A retrospective chart review of eyes that underwent IVT aflibercept injections for nvAMD between May 2014 and March 2018 was performed. The primary outcome was the change in best corrected visual acuity (BCVA) at 12 months. Secondary outcomes included the change in central retinal thickness (CRT), subretinal fluid (SRF) and intraretinal fluid (IRF).

Results: Data from 213 eyes of 213 patients (138 female, 65%) met the inclusion criteria. The mean (SD) age of the patients was 80.4 (± 9.2) years. The mean baseline BCVA (0.92 ± 0.50 logMAR, improved by 0.20 (± 0.40) logMAR units at 12 months (p < 0.001). Seventy-two (34%) eyes gained ≥ 0.3 logMAR and 47 (22%) eyes achieved BCVA ≤ 0.3 logMAR at 12 months. Baseline BCVA, patient age, and the number of aflibercept injections received were predictors of the change in BCVA at 12 months. Mean CRT improved from 347 (± 117) µm at baseline to 246 (± 55) µm at 12 months (p < 0.001). The percentage of eyes with SRF and IRF on SD-OCT declined from 63 to 21% and from 60 to 26% at 12 months, respectively.

Conclusion: A TAE regimen of IVT aflibercept in treatment naïve nvAMD is associated with good visual and anatomical outcomes in routine clinical practice. Resolution of exudation occurred in about half of nvAMD cases at 12 months. Individualized administration of IVT aflibercept may reduce injection burden.

Keywords: Aflibercept; Age-related macular degeneration; Anti-VEGF; Treat-and-extend; VEGF Trap-eye.