Five-year Outcome of Aflibercept Administration with “Treat and Extend” for Neovascular Age-Related Macular Degeneration

Purpose: This study aimed to evaluate the outcomes of aflibercept treatment using a treat-and-extend (TAE) regimen over up to 5 years in Japanese patients with neovascular age-related macular degeneration (nAMD). Patients and Methods: This retrospective study included 126 consecutive treatment-naïve nAMD patients (126 eyes) who received at least three monthly intravitreal aflibercept (IVA) injections as a loading phase, followed by a treat-and-extend (TAE) regimen with follow-up for 5 years. Injection intervals were adjusted every 2 weeks and could be extended up to 16 weeks based on macular condition. Treatment was suspended if patients received 3 injections at 16-week intervals and the macula remained dry (defined as “monitoring”). Ophthalmic exams were conducted at each visit to assess disease activity. Results: The mean logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) at baseline was 0.42 ± 0.036. Following loading injections, the mean BCVA exhibited a significant improvement. Although it subsequently declined, it sustained the initial visual acuity. The average macular thickness (CMT) was significantly reduced and maintained throughout the follow-up period. The number of aflibercept injections decreased significantly from the second year and gradually decreased during the follow-up period. Intravitreal aflibercept (IVA) treatment could be discontinued in 36 (44%) cases during the follow-up period. However, 12 of these eyes (33%) experienced recurrence. Notably, significant recurrence was observed in patients who received a higher total number of aflibercept injections. Macular atrophy was significantly more likely to occur in cases with occult macular neovascularization (MNV) with subretinal hemorrhage than in cases with other forms of nAMD. Conclusion: The long-term outcomes of IVA treatment utilizing TAE regimens for nAMD in real-world practice have demonstrated favorable results, including the maintenance of visual acuity and improvement in CMT over a 5-year period.