Long-Term Effects of Aflibercept Injections on Lesion-Free Retina in Eyes with Neovascular Age-Related Macular Degeneration

Purpose: The study aimed to investigate the adverse effects of long-term aflibercept injections on the lesion-free retina in eyes with neovascular age-related macular degeneration (nAMD). Methods This retrospective, comparative study consisted of aflibercept-injected 48 eyes diagnosed with nAMD, treatment-naive 42 nAMD eyes, and 40 eyes with drusen in the control group. The measurements were done with spectral-domain optical coherence tomography. The center of the Early Treatment Diabetic Retinopathy Study (ETDRS) grid was centered at a 3-mm distance from the foveola temporally. Total retinal thickness and the thicknesses of each retinal layer in the outer temporal subfield of the ETDRS grid were measured separately. One-way ANOVA test for normally distributed variables was applied for analyses of differences for the comparison of the results between groups. A p-value of less than 0.05 was considered statistically significant. Results The median follow-up time was 51.35 ± 20.92 months. Retinal nerve fiber layer thickness (RNFL) was highest in the treated nAMD group, followed by the treatment-naive nAMD and drusen groups. However, the difference between the treated nAMD and drusen groups showed statistical significance (17.77 ± 2.57 µm; 16.15 ± 1.81 µm, p < 0.05). Total retina, ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer, outer nuclear layer, and retina pigment epithelium thicknesses didn’t show a statistically significant difference between the groups (p > 0.05). Conclusions The study demonstrated an increase in RNFL thickness in the lesion-free retina after long-term aflibercept treatments. This finding may suggest the expansion of AMD pathology to the normal-appearing retina rather than the aflibercept effect.