Factors determining timing of first recurrence after three loading aflibercept injections in newly diagnosed neovascular age-related macular degeneration

Purpose: To investigate factors affecting timing of the first recurrence after three loading aflibercept injections in patients with newly diagnosed neovascular age-related macular degeneration (NAMD). Study design: Retrospective chart review. Methods: A retrospective study was conducted on 193 eyes from 193 patients newly diagnosed with NAMD who received monthly three loading aflibercept injections and a fourth injection by pro-re-nata therapy regimen for recurrence between January 2016 and May 2023. Recurrence was defined as reaccumulation of subretinal or intraretinal fluid or new or increased retinal or subretinal hemorrhage. Patients were divided into two groups. One group received a fourth injection within 12 weeks after the third dose of aflibercept (Group A) and the other group received a fourth injection after 12 weeks (Group B). Results: In group A (65 eyes) compared to group B (128 eyes), the frequency of polypoidal choroidal vasculopathy (PCV) was higher (60.0%: 36.7%), the frequency of retinal angiomatous proliferation was lower (6.2%: 18.0%), and the optical coherence tomography (OCT) findings showed that pigment epithelial detachment (PED) of hollow type was more likely to be observed compared to solid type (OR=3.14, p=0.013) or mixed type (OR=3.67, p=0.003) of PED; sharply peaked PED was more common (OR=2.05, p=0.045) and less likely to be seen in females (OR=0.46, p=0.034). Conclusion: In patients with newly diagnosed NAMD who received three injection loading doses of aflibercept, earlier recurrence was predicted when PCV was present, when a hollow type of PED was observed on OCT, and when the patient was a man.