Early Real-World Anatomic Response and Interval Extension After Switching to Aflibercept 8 mg in Previously Treated Eyes With Neovascular AMD or Pachychoroid-Related Macular Neovascularization

To evaluate early anatomic response and treatment-interval behavior after switching to aflibercept 8 mg in previously treated eyes with neovascular AMD or pachychoroid macular neovascularization under routine clinical practice. Retrospective consecutive observational case series. Sixty-six patients (74 eyes) with previously treated macular neovascularization switched to aflibercept 8 mg. Clinical records and OCT imaging were reviewed at standardized visits: immediately before switching (Injection 0), at the first aflibercept 8 mg injection (Injection 1), and at the second aflibercept 8 mg injection (Injection 2). The pre-switch interval (α), first aflibercept 8 mg interval (β), and early extension interval (γ) were derived from electronic timestamps. OCT biomarkers were evaluated in a time-matched fashion to minimize interval-related confounding. Primary outcomes included paired changes in central foveal thickness (CFT), subretinal fluid (SRF), intraretinal fluid (IRF), pigment epithelial detachment (PED) height, hyperreflective material (HRM). Secondary outcomes included best-corrected visual acuity (BCVA) and early interval extension. Paired change in OCT biomarkers, BCVA (logMAR), and early interval extension relative to α. After one aflibercept 8 mg injection, CFT decreased by a median of −13.5 μm (95% CI, −20.5 to −7.0; p < 0.0001), PED height by −12.5 μm (95% CI, −22.0 to −6.0; p < 0.0001), SRF prevalence decreased from 54.1% to 35.1% (p < 0.001) and IRF from 47.3% to 35.1% (p < 0.05); 25.4% of wet eyes at baseline achieved complete fluid resolution. BCVA remained stable (median change 0.00 logMAR). Median pre-switch interval (α) was 10.0 weeks (IQR, 7.25–12.0) while median β was 10.0 weeks (IQR, 8.0–13.0), representing an effectively matched interval. Median γ increased to 12.0 weeks (IQR, 10.0–14.0), corresponding to a +2.0-week extension versus α (p < 0.0001); 66.2% of eyes achieved ≥2-week extension by γ. In previously treated eyes with neovascular AMD and pachychoroid-related macular neovascularization, switching to aflibercept 8 mg resulted in early, time-matched anatomic improvement and enabled interval extension without a mandated loading phase. Longer follow-up is needed to confirm durability and safety.