Intravitreal aflibercept for exudative age-related macular degeneration with good visual acuity: 2-year results of a prospective study

Figures & data

Table 1 Enrolled patient characteristics

Characteristics	Mean (SD, range) or number
Age, years	67 (9, 50 to 88)
Sex
Male	30 eyes
Female	17 eyes
Subtype
Typical AMD	22 eyes
Type 1 PCV	15 eyes
Type 2 PCV	10 eyes
BCVA	0.10 (0.11, −0.08 to 0.26)
CMT (µm)	320 (100, 200 to 700)

Abbreviations: AMD, age-related macular degeneration; BCVA, best-corrected visual acuity; CMT, central macular thickness; PCV, polypoidal choroidal vasculopathy.

Figure 1 Flow diagram of the study.

Abbreviation: PDT, photodynamic therapy.

Table 2 Baseline characteristics of tAMD, type 1 PCV, and type 2 PCV

	tAMD (n=18)	Type 1 PCV (n=12)	Type 2 PCV (n=9)	P-value
Age (years)	69 (11)	65 (9)	67 (9)	0.5
Sex (male:female)	15:3	7:5	4:5	0.1
BCVA (logMAR)	0.059 (0.14)	0.045 (0.10)	0.041 (0.15)	0.9
GLD (µm)	2,500 (2,100)	3,400 (1,300)	2,400 (1,100)	0.09
CMT (µm)	260 (120)	230 (51)	250 (62)	0.7

Notes: Data expressed as mean (SD). P-value using ANOVA, except sex (Fisher’s exact test) and GLD (Kruskal–Wallis test).

Abbreviations: ANOVA, analysis of variance; BCVA, best-corrected visual acuity; CMT, central macular thickness; GLD, greatest linear diameter; logMAR, logarithm of minimum angle of resolution; PCV, polypoidal choroidal vasculopathy; tAMD, typical age-related macular degeneration.

Figure 2 Indocyanine green angiogram of representative cases of type 1 and 2 PCV.

Notes: (A) Type 1 PCV at initial injection. (B) Type 1 PCV at 12 months. Polypoidal lesions are enlarged and number of polyps is increased. (C) Type 1 PCV at 24 months. Some polyps are enlarged and the lesions remain unchanged. (D) Type 2 PCV at initial injection. (E) Type 2 PCV at 12 months. Polypoidal lesions have disappeared. (F) Type 2 PCV at 24 months. No reappearance of polypoidal lesions.
Abbreviation: PCV, polypoidal choroidal vasculopathy.

Figure 3 BCVA over 2 years of treatment (mean, SD).

Notes: Thirty-nine eyes with wet age-related macular degeneration and BCVA of ≥0.3 logMAR received three monthly intravitreal injections of aflibercept (IVA) followed by IVA every other month for up to 12 months and then with a modified treat-and-extend regimen from 12 to 24 months. Mean BCVA of 0.058 (20/22 Snellen equivalent) at 12 months significantly improved from initial mean BCVA of 0.097 (20/25 Snellen equivalent; paired t-test, P=0.03). Mean BCVA of 0.066 (20/23 Snellen equivalent) at 24 months was not significantly different from initial mean BCVA (paired t-test, P=0.09). *P<0.05.
Abbreviations: BCVA, best-corrected visual acuity; IVA, intravitreal aflibercept; logMAR, logarithm of minimum angle of resolution.

Figure 4 CMT over 2 years of treatment (mean, SD).

Notes: Thirty-nine eyes with wet age-related macular degeneration. Mean CMT significantly improved at 12 months (250 µm) and 24 months (240 µm) compared with baseline (320 µm) (paired t-test, P=0.002 and 0.0005, respectively). *P<0.05.
Abbreviation: CMT, central macular thickness.

Figure 5 BCVA and CMT over 2 years of treatment in tAMD (tAMD [AMD] without PCV and retinal angiomatous proliferation) and PCV (mean, SD).

Notes: *P<0.05. (A) Solid line: 18 eyes with tAMD. Mean BCVA (0.070) at 12 months significantly improved from initial mean BCVA (0.13) (paired t-test, P=0.05). Mean BCVA (0.10) at 24 months is not significantly improved from initial mean BCVA (0.13) (paired t-test, P=0.2). Broken line: 21 eyes with PCV. Mean BCVA (0.048) at 12 months and (0.036) at 24 months are not significantly improved from initial mean BCVA (0.071) (paired t-test, P=0.2 and 0.2, respectively). (B) Solid line: mean CMT of tAMD patients tended to be improved at 12 months (260 µm) and 24 months (260 µm) than at baseline (320 µm) (paired t-test, P=0.08 and 0.07, respectively). Broken line: mean CMT of PCV patients significantly improved at 12 months (240 µm) and 24 months (220 µm) than at baseline (310 µm) (paired t-test, P=0.002 and <0.0001, respectively).
Abbreviations: AMD, age-related macular degeneration; BCVA, best-corrected visual acuity; CMT, central macular thickness; logMAR, logarithm of minimum angle of resolution; PCV, polypoidal choroidal vasculopathy; tAMD, typical age-related macular degeneration.

Figure 6 BCVA and CMT over 2 years of treatment in type 1 PCV and type 2 PCV (mean, SD).

Notes: *P<0.05. (A) Solid line: 12 eyes with type 1 PCV. Mean BCVA (0.059) at 12 months and (0.068) at 24 months are not significantly improved from initial mean BCVA (0.094) (paired t-test, P=0.4 and 0.07, respectively). Broken line: nine eyes with type 2 PCV. Mean BCVA (0.032) at 12 months and (−0.0062) at 24 months are not significantly improved from mean initial BCVA (0.040) (paired t-test, P=0.2 and 0.3, respectively). (B) Solid line: mean CMT of type 1 PCV tended to be improved at 12 months (230 µm) and 24 months (220 µm) than at baseline (320 µm) (paired t-test, P=0.09 and 0.03, respectively). Broken line: mean CMT of type 2 PCV improved at 12 months (250 µm) and 24 months (230 µm) than at baseline (300 µm) (paired t-test, P=0.04 and 0.02, respectively).
Abbreviations: BCVA, best-corrected visual acuity; CMT, central macular thickness; logMAR, logarithm of minimum angle of resolution; PCV, polypoidal choroidal vasculopathy.

Table 3 Analysis of baseline characteristics and mean change of logMAR BCVA

	Mean change of logMAR BCVA 12 months	P-value	24 months	P-value
Female	−0.0063	0.3	−0.015	0.6
Male	−0.00551		−0.039
PVD+	−0.033	0.7	−0.017	0.4
PVD−	−0.49		−0.055
IRF+	−0.038	0.9	−0.011	0.4
IRF−	−0.053		−0.025
SRF+	−0.049	0.3	−0.024	0.5
SRF−	0.048		−0.063
PED+	−0.047	0.5	−0.046	0.3
PED−	−0.016		−0.013
hPED+	−0.04	1	0.016	0.5
hPED−	−0.039		−0.037
Typical AMD	−0.057	0.4	−0.026	0.9
PCV	−0.024		−0.035
SRH+	−0.12	0.02*	−0.010	0.06
SRH−	−0.011		−0.0056

Notes: P-value using linear regression analysis (Fisher’s exact test).

* P<0.05.

Abbreviations: AMD, age-related macular degeneration; BCVA, best-corrected visual acuity; hPED, hemorrhagic PED; IRF, intraretinal fluid; logMAR, logarithm of minimum angle of resolution; PCV, polypoidal choroidal vasculopathy; PED, pigment endothelial detachment; PVD, posterior vitreous detachment; SRF, subretinal fluid; SRH, subretinal hemorrhage.

Figure 7 BCVA and CMT over 2 years of treatment in eyes with and without baseline SRH (mean, SD).

Notes: *P<0.05. (A) Solid line: 10 eyes with baseline SRH. Mean BCVA (−0.0022) at 12 months and (0.013) at 24 months are significantly improved than initial mean BCVA (0.12) (paired t-test, P=0.003 and 0.008, respectively). Broken line: 29 eyes without baseline SRH. Mean BCVA (0.079) at 12 months and (0.084) at 24 months are not significantly different from initial mean BCVA (0.082) (paired t-test, P=0.3 and 0.4, respectively). (B) Solid line: mean CMT of eyes with baseline SRH significantly improved at 12 months (230 µm) and at 24 months (210 µm) than at baseline (350 µm) (paired t-test, P=0.02 and 0.009, respectively). Broken line: mean CMT of eyes without baseline SRH significantly improved at 12 months (250 µm) and at 24 months (250 µm) than at baseline (300 µm) (paired t-test, P=0.03 and 0.01, respectively). Change of logMAR BCVA at 12 months is −0.12 with SRH and −0.011 without SRH (P=0.02). The change of logMAR BCVA at 24 months is −0.010 with SRH and −0.0056 without SRH (P=0.06).
Abbreviations: BCVA, best-corrected visual acuity; CMT, central macular thickness; logMAR, logarithm of minimum angle of resolution; PCV, polypoidal choroidal vasculopathy; SRH, subretinal hemorrhage.