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Best-corrected visual acuity (BCVA), central retinal thickness (CRT), central choroidal thickness (CCT), and exudative findings (subretinal fluid [SRF], intraretinal fluid [IRF], and subretinal hyperreflective material [SHRM]) were assessed at baseline and at 1, 2, and 4 months. Pachychoroid and polypoidal lesion status was determined using multimodal imaging. Longitudinal changes were analyzed using linear mixed-effects models, with subgroup analyses by pachychoroid and polypoidal lesion status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At 4 months, mean BCVA improved from 0.27\u2009\u00b1\u20090.33 to 0.20\u2009\u00b1\u20090.31 logMAR (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005), CRT decreased from 382.1\u2009\u00b1\u2009189.7 to 231.3\u2009\u00b1\u2009109.1\u00a0\u03bcm, and CCT from 263.0\u2009\u00b1\u2009146.5 to 231.0\u2009\u00b1\u2009127.2\u00a0\u03bcm (both\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). The dry macula rate (absence of both SRF and IRF) increased from 17.8% to 75.6% (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Functional and retinal anatomical responses were broadly consistent across phenotypes, with no significant time-by-phenotype interactions for BCVA or CRT. Pachychoroid eyes showed a greater CCT reduction (interaction\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), but this was no longer significant after adjusting for baseline CCT. As exploratory observations, the time-by-polypoidal-lesion interaction for BCVA was not significant (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.052), and residual SHRM at 4 months was present in 0% of polypoidal-lesion eyes versus 22.2% of those without (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.067).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Intravitreal aflibercept 8\u00a0mg led to significant short-term improvements in BCVA, CRT, CCT, and exudative findings in treatment-na\u00efve nAMD, with benefit observed irrespective of pachychoroid or polypoidal lesion status.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40942-026-00901-7","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T05:55:21Z","timestamp":1784094921000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world functional and anatomical outcomes of intravitreal aflibercept 8\u00a0mg in treatment-na\u00efve neovascular age-related macular degeneration: a phenotype-based analysis by pachychoroid and polypoidal lesion status"],"prefix":"10.1186","volume":"12","author":[{"given":"Amiko","family":"Matsuyama","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1930-3960","authenticated-orcid":false,"given":"Akiko","family":"Miki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiki","family":"Oka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eisuke","family":"Ikeuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Kishimoto-Kishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuaki","family":"Miki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisanori","family":"Imai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"issue":"2","key":"901_CR1","doi-asserted-by":"publisher","first-page":"e144","DOI":"10.1016\/S2214-109X(20)30489-7","volume":"9","author":"GBD 2019 Blindness and Vision Impairment Collaborators","year":"2021","unstructured":"GBD 2019 Blindness and Vision Impairment Collaborators. 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The study protocol was approved by the Institutional Review Board of Kobe University Hospital (approval number: B250205). Given the retrospective design, the requirement for written informed consent was waived in favor of an opt-out procedure via public disclosure on the institutional website.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"During the preparation of this work, the authors used DeepL and Grammarly to assist with translation from Japanese to English and to perform grammar checking, respectively. After using these tools, the authors reviewed and edited the content as needed and took full responsibility for the content of the publication.","order":3,"name":"Ethics","label":"Use of generative AI and AI-assisted technologies in the writing process","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"137"}}