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In this prospective study the authors evaluate the effect of intravitreal aflibercept injections in the treatment of naive type 3 neovascularisation using a fixed treatment regime. Fourteen eyes of 14 patients were studied. All patients were treated with intravitreal 2.0 mg/0.05ml aflibercept injections. A fixed treatment regime of administration was used and consisted of three consecutive monthly injections, followed by two-month interval injections. Results were assessed after a12-month follow-up period. Changes of best corrected visual acuity (BCVA), central retinal thickness (CRT) and central macular volume (CMV) were recorded. Retinal pigment epithelium (RPE) atrophy with fundus autofluorescence and infrared reflectance images were also recorded and analysed. Out of a total of 14 eyes, the M:F was 5:9, and the mean age was 71 ±9 years (range 57-86 years). Seven patients were classified as phase 2, whereas seven patients were classified as phase 3 using Su et al. staging system. In five eyes, discrete intraretinal haemorrhage was observed, and in seven eyes reticular pseudodrusen were found. BCVA improved from 60.3 ± 11.7 ETDRS letters at the baseline to 70.9 ±10.3 ETDRS letters at 12-months follow-up (p=0.036). In addition, CRT and CMV statistically improved after the treatment, from 425 ±117 to 308 ±117μm (p=0.031) and from 9.52 ±1.90 to 8.29 ±0.95 mm3 (p=0.073) respectively. Four patients showed development and progression of RPE atrophy and this was associated with the presence of serous pigment epithelium detachment at the baseline. The development of a fibrotic lesion eccentric to the fovea was observed in five patients, without significant impairment of BCVA (p=0.290). The authors concluded that intravitreal aflibercept administered in a fixed treatment regime during the first year of therapy may be effective for the improvement and stabilisation of BCVA in eyes with type 3 neovascularisation. However, RPE atrophy and subretinal and intraretinal fibrosis can develop during the treatment. Limitations: Small cohort and short follow-up period. The measurement of the atrophic areas was performed by analysing the IR images, and this could limit the reliability of inter-study comparison with atrophic areas measured by fundus autofluorescence.

One-year results of fixed aflibercept treatment regime in type 3 neovascularization.
Ernest J, Manethova K, Kolar P, et al.
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Sofia Rokerya

MBBS MRCOphth FRCSI, King's College University Hospital, UK.

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