NATIVE study: Fewer subretinal aflibercept injections needed for submacular hemorrhages associated with nAMD compared with intravitreal injections
In a retrospective interventional cohort study, the investigators analyzed the outcomes of 80 patients with submacular hemorrhages who were treated with subretinal aflibercept or intravitreal aflibercept.
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Subretinal injection of aflibercept (Eylea, Regeneron Pharmaceuticals) seems to be a better management option to manage choroidal neovascularization compared with intravitreal injection with need for fewer anti-vascular endothelial growth factor (VEGF) injections,1 according to Matias Iglicki, MD, from the University of Buenos Aires, Buenos Aires, Argentina. He presented the results of the NATIVE Study on behalf of the study investigators at the World Retina Congress 2024 in Ft. Lauderdale, FL.
In a retrospective interventional cohort study, the investigators analyzed the outcomes of 80 patients with submacular hemorrhages who were treated with subretinal aflibercept or intravitreal aflibercept. All submacular hemorrhages were secondary to treatment-naïve neovascular age-related macular degeneration and all patients had undergone pars plana vitrectomy, injection of subretinal air, and injection of subretinal tissue plasminogen activator.
The main outcome measures were the changes in the best-corrected visual acuity (BCVA) and the central subfield thickness (CST) at 24 months postoperatively and the number of anti-VEGF injections over the follow-up period in each group.
The investigators found that the average duration from symptom onset to surgery was 1.26 days (range, 0–3 days). Optical coherence tomography imaging showed that all patients had subretinal hemorrhages and 29 patient (36.3%) had hemorrhages under the retinal pigment epithelium.
Analysis of the patient records showed that 41 patients (51.25%) were treated with subretinal aflibercept, and 39 patients (48.75%) were treated with intravitreal aflibercept injections. The 2 groups did not differ significantly in age and gender.
In both groups, the BCVA and CST improved significantly (p < 0.001 for both comparisons).
The investigators reported a significant differences in the mean numbers of anti-VEGF injections administered during the follow-up period. The number was significantly lower in the patients who received subretinal injections (6.2 versus 15.5; p < 0.0001).
The authors concluded, “This study shows better management of choroidal neovascularization, with a statistically significant lower need for anti-VEGF injections when treated with subretinal aflibercept compared to intravitreal application.”
