Choroidal Thickness Changes After Intravitreal Aflibercept Injections in Treatment-Naive Neovascular AMD

Introduction Choroidal thickness (CT) plays an important role in the pathogenesis of various ocular diseases, including neovascular age-related macular degeneration (nAMD). Previous studies evaluated the CT variations after anti-vascular endothelial growth factor (VEGF) injections in patients with nAMD, but the results are still controversial. The present study aimed to evaluate the CT at different times (15, 30, 60, 90, and 365 days) after intravitreal aflibercept injections and its correlation with the baseline CT in treatment-naive patients with nAMD. Secondly, the study evaluated the correlation between CT variation at 365 days and the number of intravitreal injections received. Methods This was a prospective, open-label, single-arm pilot study. Twenty-one treatment-naive nAMD eyes were enrolled. The study population underwent three monthly aflibercept injections (loading phase) and additional injections as needed (pro re nata regimen). A complete ophthalmological examination, including optical coherence tomography (OCT) was performed at each visit. CT was measured manually by two independent observers. All patients were evaluated at baseline and at 15, 30, 60, 90, and 365 days after the first intravitreal injection. Results CT showed a statistically significant reduction at days 15, 90, and 365 in comparison to baseline. However, the major reduction of CT was observed at day 15 and in eyes with a thicker choroid at baseline. No significant correlation between CT variation and the number of injections performed was found. Conclusion Our findings contribute to clarifying the role of aflibercept injections in choroidal vasculature, confirming its effect after the first 2 weeks. Moreover, CT can be considered as a potential biomarker, as it reflects the pharmacological effect of anti-VEGF drugs.

Automated summary

This study investigated the choroidal thickness (CT) changes after intravitreal aflibercept injections in treatment-naive patients with neovascular age-related macular degeneration (nAMD). The results showed a significant reduction in CT at days 15, 90, and 365 compared to baseline, with the major reduction observed at day 15 and in eyes with thicker choroid at baseline. There was no significant correlation between CT variation and the number of injections performed. These findings contribute to understanding the role of aflibercept injections in choroidal vasculature and suggest that CT can serve as a potential biomarker.