Outcomes of Treat-and-Extend using Aflibercept in Type 3 Macular Neovascularization: A Prospective Clinical Trial.

Purpose: To evaluate the clinical outcomes of a treat-and-extend(TAE) regimen using aflibercept for type 3 macular neovascularization(MNV).

Methods: In this prospective phase 4 clinical trial, 25 patients with type 3 MNV underwent TAE with aflibercept for over 76 weeks. Following an initial three 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(BCVA) from diagnosis to 76 weeks. Secondary outcomes included the number of injections, changes in central retinal thickness(CRT) over 76 weeks, and changes in the incidence of subretinal fluid(SRF), intraretinal fluid(IRF), subretinal hyperreflective material(SHRM), and serous pigment epithelial detachment(PED).

Results: The mean number of injections over 76 weeks was 8.5±0.8. Baseline BCVA was 53.6±13.0 letters, which improved by 4.6 letters to 58.2±15.6 letters at 76 weeks (P=0.044). CRT significantly decreased from 488.1±204.2 µm at diagnosis to 247.8±57.0 µm at 76 weeks (P<0.001). The incidences of SRF, IRF, SHRM, and serous PED decreased markedly from 56%, 100%, 52%, and 84% at baseline to 8%, 4%, 4%, and 8%, respectively, at 76 weeks.

Conclusion: TAE with aflibercept for > 76 weeks improved BCVA and significantly reduced CRT in those with type 3 MNV. At 76 weeks, most patients maintained a dry macula, indicating that this approach is an effective and efficient treatment strategy for type 3 MNV.