Real-World Outcomes of Aflibercept 2 mg Using a Treat-and-Extend Protocol for Neovascular Age-Related Macular Degeneration: A 24-Month Retrospective Study in a Chinese Population

Purpose: To evaluate the long-term efficacy of aflibercept using a treat-and-extend (T&E) protocol in Chinese patients with neovascular age-related macular degeneration (nAMD) and to explore baseline imaging predictors of treatment response. Methods: This retrospective, real-world study included patients with treatment-naïve nAMD who received intravitreal aflibercept (2.0 mg) under a T&E regimen for 24 months. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and OCT-derived structural features were assessed. Patients were stratified into effective and non-effective groups based on visual outcomes at 24 months. Results: A total of 37 eyes were included. Compared with baseline (0.71± 0.48 logMAR), BCVA improved significantly at 3 months (0.58± 0.50, p=0.029), 6 months (0.51± 0.32, p< 0.01), and remained improved at 24 months (0.57± 0.44, p=0.002). Mean ΔBCVA at 24 months was − 0.15± 0.27 logMAR. CMT decreased from 409.89± 219.24 μm at baseline to 277.43± 113.92 μm at 3 months (p< 0.001), with sustained reductions throughout follow-up (ΔCMT − 145.71± 239.50 μm at 24 months). Subretinal fluid (SRF), intraretinal fluid (IRF), and pigment epithelial detachment height (PEDH), resolved significantly during follow-up (all p ≤ 0.05), whereas hyperreflective dots (HRD), subretinal hyperreflective exudation (SHE), fibrosis, and macular atrophy (MA) tended to increase progressively. In subgroup analysis, the effective group showed higher baseline CMT (473 vs 293 μm, p=0.015), more frequent SRF (70.8% vs 30.8%, p=0.019), and more HRD (79.2% vs 46.2%, p=0.041). Multivariate logistic regression confirmed higher baseline CMT (OR=1.01, p=0.030) and SRF presence (OR=5.40, p=0.028) as independent predictors of visual response. Conclusion: Intravitreal aflibercept administered under a T&E regimen provides sustained visual and anatomical benefits in Chinese patients with nAMD. Baseline OCT features, particularly CMT and SRF, are valuable predictors of treatment efficacy, supporting their role in individualized therapeutic decision-making.