• Retina/Vitreous

    Intravitreal aflibercept injection was tested as a prophylactic treatment against conversion to exudative AMD in high-risk eyes. No benefit was found.  

    Study design

    A single-masked, sham-controlled, randomized clinical trial was performed at 4 US clinical sites. Enrolled patients had intermediate AMD in 1 eye (study eye), defined as presence of more than 10 medium drusen (≥63 to <125 μm), at least 1 large druse (≥125 μm), and/or retinal pigmentary changes, and exudative AMD in the fellow eye. Patients were randomized 1:1 to quarterly intravitreal aflibercept or sham injection.

    Outcomes

    The primary outcome was conversion to exudative AMD within 24 months. Diagnosis of exudative AMD was based on multimodal imaging results, including color fundus photography, SD-OCT, and fluorescein angiography. This diagnosis included evaluation for the presence of choroidal neovascularization (CNV) on fluorescein angiography and presence of subretinal and/or intraretinal fluid associated with CNV. Of 128 patients enrolled, 127 (63 in the study group and 64 in the sham) were included in the primary analysis.

    Limitations

    Further studies are needed to detect a difference in conversion to exudative AMD, specifically in patients who had non-exudative CNV membranes at baseline as they have a higher rate of conversion to exudative AMD. Further studies may be warranted to study the impact of more frequent injection regimens.

    Clinical significance

    At this point there are no data that suggest that intravitreal aflibercept prevents conversion to exudative AMD in patients with intermediate AMD in one eye and exudative AMD in the other eye. Fortunately, no difference in the progression of geographic atrophy was found between the treatment and sham arms.