Real-world outcomes of aflibercept 8 mg in patients previously treated for neovascular age-related macular degeneration.

Abstract

Purpose: To evaluate visual, anatomical and safety outcomes of aflibercept 8 mg in previously treated patients with neovascular age-related macular degeneration (nAMD).

Methods: This retrospective study included nAMD patients switched to aflibercept 8 mg from prior anti-VEGF therapies at Sahlgrenska University Hospital between February 2024 and February 2025. Data on best-corrected visual acuity (BCVA), central retinal thickness (CRT), pigment epithelial detachment (PED) height, fluid status, treatment intervals, time to fluid recurrence and adverse events were collected.

Results: 181 eyes (167 patients; mean age 80.4 ± 8.5 years; 67.7% female) were included, with a median follow-up of 12.9 weeks (range 4.1-48.1). A total of 415 injections were administered (mean 2.1 ± 1.5 per eye). BCVA remained stable (baseline 0.46 ± 0.31 logMAR; post-treatment 0.47 ± 0.37 logMAR; p = 0.18). CRT decreased significantly (-19.5 ± 47.2 μm; p < 0.001), as did PED height (-37.4 ± 68.4 μm; p < 0.001). Intraretinal fluid prevalence decreased from 34.3% to 19.3% (p < 0.001) and subretinal fluid from 53.0% to 33.7% (p < 0.001). The median maximal dry interval achieved was nine weeks, and analysis of interval extension showed a statistically significant mean increase of 1.27 ± 4.24 weeks overall (p = 0.0009), particularly in eyes dry at baseline. The median time to fluid recurrence among those with reactivation was ten weeks. Higher baseline CRT predicted greater CRT reduction (-44.1 μm per 100 μm increase; p < 0.001) but shorter dry intervals. Safety was favourable, with one case (0.6% per eye; 0.2% per injection) of mild anterior uveitis and no cases of intraocular pressure elevation.

Conclusions: Switching to aflibercept 8 mg led to stable vision, significant anatomical improvements, extended treatment intervals and a favourable short-term safety profile. Longer follow-up is warranted.