One-Month Real-World Comparison of Aflibercept 8 mg Versus 2 mg in Treatment-Naïve and Previously Treated Eyes with Neovascular Age-Related Macular Degeneration

Background/Objectives: The relative efficacy of 8 mg aflibercept compared to 2 mg in treating neovascular age-related macular degeneration (nAMD) has not been fully established. This study aims to compare the visual and anatomical outcomes of aflibercept 8 mg versus 2 mg in patients with nAMD in both treatment-naïve individuals with no history of anti-VEGF treatment and those previously treated with intravitreal injections. Methods: This retrospective study included 13 eyes treated with aflibercept 8 mg and 14 eyes with aflibercept 2 mg in treatment-naïve patients, along with 15 eyes switched to aflibercept 8 mg previously treated with other intravitreal injections and 15 eyes continued on aflibercept 2 mg in patients. Baseline and one-month post-injection changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were assessed. Results: In treatment-naïve patients, the aflibercept 8 mg group showed a significant improvement in BCVA (logMAR 0.19 ± 0.23 to 0.13 ± 0.20, p = 0.0156), while the 2 mg group did not. Both doses reduced CMT significantly, with a greater reduction in the 8 mg group (dCMT 28.60% vs. 24.08%, p = 0.0220). In previously treated patients, no significant changes in BCVA were noted in either group; however, both groups showed significant reductions in CMT. Conclusions: Real-world data demonstrated that aflibercept 8 mg led to substantial improvements in anatomical outcomes one month after injection, irrespective of previous intravitreal injection history. However, significant improvements in visual outcomes were observed exclusively in treatment-naïve patients. Further large-scale, long-term studies are required to determine the proportion of patients who experience improvement and to assess whether these improvements are maintained over time.