Early Outcome Analysis of Intravitreal Aflibercept 8 mg Treatment in Naïve Patients with Neovascular Age-Related Macular Degeneration Using Artificial Intelligence.

introductionNeovascular age-related macular degeneration (nAMD) is one of the leading causes of vision loss, often requiring frequent injections. Our aim is to report the early outcomes of intravitreal aflibercept (IVA) 8 mg treatment in naïve patients with nAMD.

methodsAn observational, retrospective, monocentric study was conducted at Swiss Visio Montchoisi, Lausanne, Switzerland. A total of 51 eyes of 48 patients with naïve macular neovascularization (MNV) secondary to AMD received a loading phase of three-monthly IVA followed by a monthly observational phase until fluid recurrence. At each visit, all patients had a full ophthalmological exam, including spectral-domain optical coherence tomography (SD-OCT), which was analysed manually and with artificial intelligence (AI). The main outcomes were best-corrected visual acuity (BCVA), central subfield thickness (CST), maximal pigment epithelial detachment (PED) height, presence or absence of intraretinal fluid (IRF) and subretinal fluid (SRF) on SD-OCT, and mean volumetric changes in IRF, SFR, and PED using AI at baseline and month 1, 2, 3, and 6.

resultsMean age at baseline was 79.94 ± 7.29 years, and 81.25% of patients were female. At baseline, mean BCVA was 70.44 ± 12.48 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, mean CST was 339.8 ± 174.6.0 μm, and mean Maximal PED height was 214.3 ± 115.1 μm. After loading and at month 6, BCVA significantly increased by 2.47 and 3.41 ETDRS letters, respectively. Mean CST and PED height significantly decreased to 231.9 ± 68.69 μm and 137.6 ± 68.53 μm, respectively, at month 6. Qualitative and AI-quantified biomarkers significantly decreased after loading and at month 6. A mean interval of 9.67 ± 3.87 weeks was reached with a mean number of 4.63 ± 1.01 injections at the time of the last observation. Baseline IRF and HRF were negative predictors of functional outcomes in the short term. One patient with sterile vitritis benefited from vitrectomy and topical treatment.

conclusionsAflibercept intravitreal injections in the treatment of naïve patients with wet AMD demonstrated rapid improvement of functional and anatomical parameters, particularly regarding fluid control and quantitative biomarkers on OCT. A comprehensive analysis of follow-up visits will be performed to confirm our early results.