Impact of Early Residual Fluid after Aflibercept Loading on 12-Month Outcomes in Neovascular Age-Related Macular Degeneration

Purpose: To evaluate the impact of early residual fluid (ERF) following aflibercept loading on 12-month anatomical and functional outcomes in patients with neovascular age-related macular degeneration (nAMD). Methods: This retrospective study included 111 eyes of 107 treatment-naïve nAMD patients. ERF was defined as the presence of intraretinal fluid (IRF) and/or subretinal fluid (SRF) observed after three loading doses of aflibercept. Patients were divided into ERF (n = 28) and ERF-free (n = 83) groups. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were assessed at baseline, post-loading, and at 12 months. Subgroup analyses were conducted based on fluid location within the ERF group. Results: ERF was observed in 25.2% of eyes after loading. The ERF group exhibited significantly greater CMT at all time points (P < 0.050). Although BCVA did not differ significantly between groups, the ERF group required a significantly higher injection burden (7.36 ± 1.95 vs. 5.29 ± 1.44; P = 0.001). Subgroup analysis within the ERF group revealed that eyes with IRF had worse baseline BCVA (P = 0.038) and a higher rate of persistent IRF at 12 months (87.5%). Multivariate analysis identified post-loading ERF (OR: 3.41, P = 0.046), thicker post-loading CMT (OR: 1.01, P = 0.030), and higher injection frequency (OR: 1.31, P = 0.022) as independent predictors of residual fluid at 12 months. Conclusions: ERF after aflibercept loading is a significant independent predictor of long-term fluid persistence. While ERF signifies a more recalcitrant disease course, comparable visual outcomes can be achieved through proactive, individualized treatment.