International journal of retina and vitreous · 2026
Real-world functional and anatomical outcomes of intravitreal aflibercept 8 mg in treatment-naïve neovascular age-related macular degeneration: a phenotype-based analysis by pachychoroid and polypoidal lesion status.
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Matsuyama Amiko, Miki Akiko, Oka Toshiki, Ikeuchi Eisuke, Kishimoto-Kishi Maya, Miki Katsuaki, Imai Hisanori, Nakamura Makoto
Аннотация
BACKGROUND: To evaluate the short-term functional and anatomical outcomes of intravitreal aflibercept 8 mg in treatment-naïve neovascular age-related macular degeneration (nAMD), and to explore whether the early treatment response varied according to pachychoroid and polypoidal lesion status.
METHODS: This retrospective, multicenter observational study evaluated 45 treatment-naïve eyes of 45 patients with nAMD who received three monthly loading injections of aflibercept 8 mg. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), central choroidal thickness (CCT), and exudative findings (subretinal fluid [SRF], intraretinal fluid [IRF], and subretinal hyperreflective material [SHRM]) were assessed at baseline and at 1, 2, and 4 months. Pachychoroid and polypoidal lesion status was determined using multimodal imaging. Longitudinal changes were analyzed using linear mixed-effects models, with subgroup analyses by pachychoroid and polypoidal lesion status.
RESULTS: At 4 months, mean BCVA improved from 0.27 ± 0.33 to 0.20 ± 0.31 logMAR (P = 0.005), CRT decreased from 382.1 ± 189.7 to 231.3 ± 109.1 μm, and CCT from 263.0 ± 146.5 to 231.0 ± 127.2 μm (both P < 0.001). The dry macula rate (absence of both SRF and IRF) increased from 17.8% to 75.6% (P < 0.001). Functional and retinal anatomical responses were broadly consistent across phenotypes, with no significant time-by-phenotype interactions for BCVA or CRT. Pachychoroid eyes showed a greater CCT reduction (interaction P < 0.001), but this was no longer significant after adjusting for baseline CCT. As exploratory observations, the time-by-polypoidal-lesion interaction for BCVA was not significant (P = 0.052), and residual SHRM at 4 months was present in 0% of polypoidal-lesion eyes versus 22.2% of those without (P = 0.067).
CONCLUSIONS: Intravitreal aflibercept 8 mg led to significant short-term improvements in BCVA, CRT, CCT, and exudative findings in treatment-naïve nAMD, with benefit observed irrespective of pachychoroid or polypoidal lesion status.
METHODS: This retrospective, multicenter observational study evaluated 45 treatment-naïve eyes of 45 patients with nAMD who received three monthly loading injections of aflibercept 8 mg. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), central choroidal thickness (CCT), and exudative findings (subretinal fluid [SRF], intraretinal fluid [IRF], and subretinal hyperreflective material [SHRM]) were assessed at baseline and at 1, 2, and 4 months. Pachychoroid and polypoidal lesion status was determined using multimodal imaging. Longitudinal changes were analyzed using linear mixed-effects models, with subgroup analyses by pachychoroid and polypoidal lesion status.
RESULTS: At 4 months, mean BCVA improved from 0.27 ± 0.33 to 0.20 ± 0.31 logMAR (P = 0.005), CRT decreased from 382.1 ± 189.7 to 231.3 ± 109.1 μm, and CCT from 263.0 ± 146.5 to 231.0 ± 127.2 μm (both P < 0.001). The dry macula rate (absence of both SRF and IRF) increased from 17.8% to 75.6% (P < 0.001). Functional and retinal anatomical responses were broadly consistent across phenotypes, with no significant time-by-phenotype interactions for BCVA or CRT. Pachychoroid eyes showed a greater CCT reduction (interaction P < 0.001), but this was no longer significant after adjusting for baseline CCT. As exploratory observations, the time-by-polypoidal-lesion interaction for BCVA was not significant (P = 0.052), and residual SHRM at 4 months was present in 0% of polypoidal-lesion eyes versus 22.2% of those without (P = 0.067).
CONCLUSIONS: Intravitreal aflibercept 8 mg led to significant short-term improvements in BCVA, CRT, CCT, and exudative findings in treatment-naïve nAMD, with benefit observed irrespective of pachychoroid or polypoidal lesion status.