OUTCOMES OF TREAT-AND-EXTEND USING AFLIBERCEPT IN TYPE 3 MACULAR NEOVASCULARIZATION: A Prospective Clinical Trial.

Abstract

To evaluate the clinical outcomes of a treat-and-extend regimen using aflibercept for Type 3 macular neovascularization. In this prospective phase four clinical trial, 25 patients with Type 3 macular neovascularization underwent treat-and-extend with aflibercept for over 76 weeks. After an initial 3 loading injections, the interval between injections was extended by 2 weeks, up to a maximum of 16 weeks, provided there was no recurrence. If recurrence occurred, the interval was reduced to 8 weeks, regardless of the previous interval. The primary outcome measure was the change in best-corrected visual acuity from diagnosis to 76 weeks. Secondary outcomes included the number of injections, changes in central retinal thickness over 76 weeks, and changes in the incidence of subretinal fluid, intraretinal fluid, subretinal hyperreflective material, and serous pigment epithelial detachment. The mean number of injections over 76 weeks was 8.5 ± 0.8. Baseline best-corrected visual acuity was 53.6 ± 13.0 letters, which improved by 4.6 letters to 58.2 ± 15.6 letters at 76 weeks ( P = 0.044). Central retinal thickness significantly decreased from 488.1 ± 204.2 µ m at diagnosis to 247.8 ± 57.0 µ m at 76 weeks ( P < 0.001). The incidences of subretinal fluid, intraretinal fluid, subretinal hyperreflective material, and serous pigment epithelial detachment decreased markedly from 56%, 100%, 52%, and 84% at baseline to 8%, 4%, 4%, and 8%, respectively, at 76 weeks. Treat-and-extend with aflibercept for >76 weeks improved best-corrected visual acuity and significantly reduced central retinal thickness in those with Type 3 macular neovascularization. At 76 weeks, most patients maintained a dry macula, indicating that this approach is an effective and efficient treatment strategy for Type 3 macular neovascularization.