OCT-angiography follow-up of choroidal neovascularization treated with treat-and- extend aflibercept regimen to avoid over-treatment

Abstract

Purpose: To propose optical coherence tomography angiography (OCT-A) for the follow-up of neovascular age-related macular degeneration (nAMD) treated with a treat-and-extend (T&E) aflibercept regimen to avoid overtreatment.

Methods: Retrospective, cohort, pilot study. We analysed 16 consecutive-treatment naïve nAMD eyes following up 2-years at the Eye Clinic, Bari, Italy. Intravitreal aflibercept injections in the T&E regimen for no less than 12 months, during which the macula was dry without any sign of intraretinal or subretinal fluid (SRF) at each visit, were performed. Parametric data were evaluated using an analysis of variance (ANOVA); any non-parametric statistical calculations were performed using the Wilcoxon and Mann-Whitney test.

Results: The average number of injections during follow-up was: 8.8 ± 1. Treatment regimen adjustments were 4 weeks (W), 8W (4 + 4), 10W (8 + 2), 12W (8 + 4, or 10 + 2). No significant CNV size change from 4 to 8W (-0.027 ± 0.22 mm², p = 0.088), and from 8 to 12W (-0.04 ± 0.11 mm², p = 0.065) were found. Likewise, no significant decrease in choriocapillaris flow (CF) was detected (p = 0.056).

Conclusion: We suggest that OCT-A may be useful in the evaluation of dry macula to decide the best approach for perchance adjusting injection intervals based on changes of CNV size.

Keywords: Aflibercept; neovascular age-related macular degeneration; optical coherence tomography angiography; treat-and-extend regimen.