Peripapillary Retinal Nerve Fibre and Ganglion Cell Layer Changes Following Intravitreal Aflibercept 8 mg Therapy in Neovascular Age-Related Macular Degeneration: A Longitudinal OCT Study

INTRODUCTION: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is the standard of care for neovascular age-related macular degeneration (nAMD) and other retinal vascular diseases. However, transient post-injection intraocular pressure elevations have raised concerns regarding potential cumulative effects on inner retinal structures, including the peripapillary retinal nerve fibre layer (pRNFL) and macular ganglion cell-inner plexiform layer (mGCIP). As longitudinal evidence on the neuro-retinal structural safety of higher-dose formulations such as aflibercept 8 mg remains limited, this study evaluated 12-month changes in pRNFL and mGCIP thickness following intravitreal aflibercept 8 mg. METHODS: This single-centre, observational longitudinal cohort study included patients with nAMD treated with intravitreal aflibercept 8 mg or aflibercept 2 mg. Patients receiving aflibercept 8 mg were prospectively enrolled, while patients treated with 2 mg aflibercept were retrospectively identified. Spectral-domain optical coherence tomography was used to assess pRNFL and mGCIP thickness at baseline and at 3, 6 and 12 months. Longitudinal within-eye changes relative to baseline were analysed, alongside inter-eye comparisons with fellow untreated eyes and between-treatment group comparisons at 12 months. RESULTS: Thirty-eight eyes from 35 patients were included. In eyes treated with aflibercept 8 mg, mGCIP thickness remained stable throughout follow-up, with no significant changes at 3, 6 or 12 months compared with baseline. At 12 months, mGCIP thickness was comparable between aflibercept 8 mg-treated eyes and fellow untreated eyes, as well as between aflibercept 8 mg and aflibercept 2 mg-treated eyes. Similarly, pRNFL thickness showed no significant global or sectoral changes over 12 months and did not differ between treatment groups. CONCLUSION: Over 12 months of follow-up, intravitreal aflibercept 8 mg was not associated with significant thinning of pRNFL or mGCIP thickness, supporting its neuro-retinal structural safety in routine clinical practice.