Early Real-World Outcomes of Intravitreal Aflibercept 8 mg for Neovascular Age-Related Macular Degeneration in France: A Retrospective Study

The aim of this work is to evaluate the early real-world effectiveness, anatomical outcomes, and safety of intravitreal aflibercept 8 mg in neovascular aged-related macular degeneration (nAMD) eyes. This retrospective single-center study included consecutive nAMD eyes treated with at least one aflibercept 8-mg injection between January 2025 and January 2026 in France. Primary outcomes were treatment interval extension and macular drying. Secondary outcomes included changes in best-corrected visual acuity (BCVA), central macula thickness (CMT), OCT biomarkers, and safety. Subgroup analyses were performed according to treatment status, responder profile, and prior anti-VEGF generation. In addition, baseline predictive factors associated with treatment interval extension, achievement of an interval ≥ 12 weeks, and dry macular status were evaluated. A sensitivity analysis was performed in eyes with ≥ 6 months of follow-up. A total of 338 eyes from 267 patients were included (82 treatment-naïve and 256 switched eyes), with a mean follow-up duration of 5.5 ± 3.3 months. In switched eyes, the mean treatment interval increased by +1.8 ± 2.4 weeks (p < 0.001), with significant gains in good responders (+ 2.7 weeks), frequent flyers (+ 0.7 weeks), and poor responders (+ 1.8 weeks) (all p < 0.001). Dry macula rates increased from 39.6% to 70.7% (p < 0.001). Among treatment-naïve eyes, 74.4% achieved a dry macula at the last visit and 97.4% at the 4-week interval following induction. In eyes with ≥ 6 months of follow-up, the interval increased by +1.6 weeks and remained significant (p < 0.001). OCT biomarkers significantly decreased during follow-up (p < 0.001), while BCVA remained stable. Early real-world use of aflibercept 8 mg was associated with improved anatomical outcomes and extended treatment intervals in treatment-naïve and previously treated nAMD eyes, while maintaining stable BCVA and a favorable safety profile. These findings support its potential to reduce treatment burden in routine clinical practice. Neovascular or wet age-related macular degeneration is a common eye disease that can cause severe vision loss. Most patients require repeated injections of medicines that block vascular endothelial growth factor to control the disease. Although these treatments are effective, frequent injections and clinic visits place a considerable burden on patients, caregivers, and healthcare systems. This study evaluated how aflibercept 8 mg performed in routine clinical practice in France. We included 338 eyes from 267 patients, including both patients receiving their first anti-VEGF treatment and patients who switched from another anti-VEGF therapy. Unlike clinical trials, treatment schedules were determined by each physician according to routine practice. Aflibercept 8 mg provided good early control of disease activity. In previously treated eyes, injection intervals became significantly longer while the proportion of eyes with a dry macula increased from about 40% before treatment to more than 70% during follow-up. Among treatment-naïve eyes, nearly three-quarters achieved a dry macula by the last follow-up visit, and almost all eyes became dry after the initial monthly treatment phase. Vision remained stable throughout follow-up, while retinal fluid and retinal thickness were significantly reduced. Only a small proportion of eyes required a switch to another treatment, and no new safety concerns were identified. These early real-world findings suggest that aflibercept 8 mg may improve disease control and allow longer intervals between injections while maintaining visual acuity. Because follow-up was relatively short and varied between patients, longer observation is needed to determine whether these effects are maintained over time.