Intravitreal afli̇bercept treatment results in naive neovascular age related macular degeneration

OBJECTIVE: To evaluate the anatomic findings obtained from intravitreal (IV) aflibercept (A) treatment in cases of newly diagnosed and untreated neovascular type age-related macular degeneration (nvAMD) and to investigate initial lesion properties affecting anatomic response. MATERIALS-METHODS: Consecutive 166 untreated eyes yet diagnosed with active nvAMD were included in this cross-sectional clinical trial. All eyes were subjected to complete ophthalmologic examination, spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA). Indocyanine green angiography was performed in addition for the patients who obtained the stain and initial lesion properties were identified. IV A treatment was performed on the eyes diagnosed with active nvAMD, according to treat and extend regimen. Control examinations were performed after 4-6 weeks later than every injection and SD-OCT imaging was repeated. Anatomic responses obtained from treatment of 166 eyes included in the study were evaluated in addition to cross sectional investigation of anatomic responses determined in the control examination on 4-6 weeks after 3rd and 6th IV A injection. Initial lesion properties affecting IV A treatment outcome were also evaluated. RESULTS: 82 of the 150 patients (54.7%) included in the study were male, 68 of them (45.3%) were female and average of their ages was 71.7±9.4 (51-90). Average best corrected visual acuity (BCVA) of 166 eyes before IV A treatment was 0.88±0.59 (0-2.1) LogMAR, IV A injection was performed 5.31±3.36 (1-17) times and average length of follow-up was 10.74± 6.27 (2-30) months. In 139 eyes subjected to IV A injection at least thrice, 76 eyes (54.6%) were determined as 'Fully Responsive' in cross-section after 4-6 weeks followed by 3rd treatment, whereas in 62 eyes subjected to IV A injection at least six times, 36 eyes (58%) were observed as 'Fully Responsive' in cross-section after 4-6 weeks followed by 6th treatment. 116 eyes (69.9%) of all cases (166 eyes) were identified as 'Fully Responsive' in the cross-section of control examination performed after 4-6 weeks followed by the last IV A injection. BCVA showed statistically significant increase with IV A treatment; whereas pigment epithelial detachment (PED) ratio showed statistically significant decrease compared to baseline. There was no statistically significant correlation between neovascularization patterns in FA, neovascularization types according to SD-OCT, PED presence, presence of polypoidal choroidal vasculopathy determined during diagnosis and anatomic response obtained from IV A treatment. The possibility of being 'Fully Responsive' was five times higher in FV PED cases during diagnosis compared to cases of other PED types. Presence of FV PED was introduced as an individual factor affecting the success. CONCLUSION: In our study it was determined that newly diagnosed, untreated nvAMD eyes benefit from IV A treatment at high level. In addition, vision was significantly improved. Important conclusions were drawn about the effects of initial lesion properties on anatomic responses obtained by treatment. Although anti-VEGF therapies are accepted as standard method in nARMD treatment recently, identification of the findings to guide the prediction of treatment outcome is rather important in terms of determining the appropriate treatment strategies in clinical practice and rationalizing the treatment expectations.