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Impact of Early Residual Fluid after Aflibercept Loading on 12-Month Outcomes in Neovascular Age-Related Macular
Eunyu Yoon1, Joo Young Shin1, Jeeyun Ahn2
1Department of Ophthalmology, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
Purpose:
To evaluate the impact of early residual fluid (ERF) following aflibercept loading on 12-month anatomical and functional outcomes in patients with neovascular age-related macular degeneration (nAMD).
Methods:
This retrospective study included 111 eyes of 107 treatment-naïve nAMD patients. ERF was defined as the presence of intraretinal fluid (IRF) and/or subretinal fluid (SRF) observed after three loading doses of aflibercept. Patients were divided into ERF (n = 28) and ERF-free (n = 83) groups. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were assessed at baseline, post-loading, and at 12 months. Subgroup analyses were conducted based on fluid location within the ERF group.
Results:
ERF was observed in 25.2% of eyes after loading. The ERF group exhibited significantly greater CMT at all time points (P < 0.050). Although BCVA did not differ significantly between groups, the ERF group required a significantly higher injection burden (7.36 ± 1.95 vs. 5.29 ± 1.44; P = 0.001). Subgroup analysis within the ERF group revealed that eyes with IRF had worse baseline BCVA (P = 0.038) and a higher rate of persistent IRF at 12 months (87.5%). Multivariate analysis identified post-loading ERF (OR: 3.41, P = 0.046), thicker post-loading CMT (OR: 1.01, P = 0.030), and higher injection frequency (OR: 1.31, P = 0.022) as independent predictors of residual fluid at 12 months.
Conclusions:
ERF after aflibercept loading is a significant independent predictor of long-term fluid persistence. While ERF signifies a more recalcitrant disease course, comparable visual outcomes can be achieved through proactive, individualized treatment.
