Purpose: To evaluate the outcome of treat-and-extend (TAE) aflibercept therapy for exudative age-related macular degeneration in the initial and maintenance phases.
Subjects and methods: Results of a clinical practice performed by one doctor in a single site were analyzed retrospectively. Subjects included 264 cases (278 eyes) (mean age: 73.7 years). Intravitreal aflibercept were administered for three consecutive months as an initial treatment. In the maintenance phase, the injection interval was adjusted to extend to a maximum of 4 months with a 1-month adjustment. Treatment was discontinued if no lesion activity was observed after two consecutive injections at 4-month intervals (the seventh injection at 15 months after the initial injection being the shortest).
Results: Exudates disappeared once in 264 eyes (95.0%) but never disappeared in 14 eyes (5.0%). The mean corrected visual acuity improved significantly from 2 to 19 months after the first injection compared to that before treatment and deteriorated thereafter; however, there was no significant difference in the mean corrected visual acuity between before and 48 months after treatment. The mean foveal thickness improved significantly from the first month onward, which was maintained until the 48th month. Drug withdrawal was possible in 88 (50.9%) of 173 eyes that received more than seven injections for the first 15 months and 28 eyes that showed recurrences. A significant improvement in visual acuity was maintained until the 36th month in the aflibercept-discontinuation group, and the patients in that group had better visual prognosis than those in the aflibercept-continuation group. The aflibercept-continuation group showed a significant visual loss after 48 months.
Conclusions: TAE regimen with a 1-month adjustment to a maximum of 4 months achieved vision improvement and was considered to be clinically useful and convenient with a relatively low burden for patients. Visual acuity could be maintained in some cases after the cessation of drug treatment, suggesting that continuous injections were not mandatory in some cases. Meanwhile, TAE regimen should be continued strictly in the eyes manifesting lesion activity.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 125: 1055-1066, 2021.