{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T22:48:25Z","timestamp":1772578105882,"version":"3.50.1"},"reference-count":23,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Regeneron Pharmaceuticals, Inc., Tarrytown, New York"},{"name":"Texas Retina Research Foundation (TRRF), Houston, Texas"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background\/Objectives: Evaluate outcomes and treatment patterns with 2 mg intravitreal aflibercept injection among patients who completed the phase 3 PANORAMA trial and enrolled in the VOYAGE (ClinicalTrials.gov identifier, NCT04708145; 12 January 2021) long-term extension study. Methods: During VOYAGE, patients were evaluated every 16 weeks and treated with 2 mg intravitreal aflibercept injection as needed depending on ophthalmoscopic examination findings. Those with no history of panretinal photocoagulation (PRP) received aflibercept if their clinician-determined diabetic retinopathy severity scale (DRSS) level was \u226547, corresponding to moderately severe non-proliferative diabetic retinopathy (NPDR). Patients with a history of PRP received aflibercept if active neovascularization was present. New or worsening diabetic retinopathy (DR) severity prompted more frequent treatment. Results: 320 patients (1 eye per patient) from 87 sites completed the PANORAMA trial. Of these, 41 patients (13% of PANORAMA completers) from 14 sites (16%) enrolled in VOYAGE after a mean interim period of 33.7 months, and 35 patients (85%) completed study visits through 1 year. At year 1 in VOYAGE, the mean number of anti-vascular endothelial growth factor (VEGF) injections increased from 1.1 per year during the interim period to 3.4 per year and was associated with stabilization or improvement in DRSS level in 81% (26\/32) of patients. Mean best-corrected visual acuity (BCVA) remained relatively stable, and mean central subfield thickness (CST) improved by 24.4 \u00b5m to 269.5 \u03bcm through year 1 of VOYAGE. There were no unexpected safety events. Conclusions: Following a mean of 3 years of routine clinical care with associated declines in DRSS level, CST, and BCVA, stabilization of DRSS level and BCVA with reductions in CST was achieved through year 1 of the VOYAGE extension study, with a concurrent increase in aflibercept dosing frequency.<\/jats:p>","DOI":"10.3390\/jpm15110555","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T10:07:03Z","timestamp":1763114823000},"page":"555","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Intravitreal Aflibercept for the Treatment of Diabetic Retinopathy Among Patients Who Completed PANORAMA: 1-Year Outcomes from the VOYAGE Extension Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Avery W.","family":"Zhou","sequence":"first","affiliation":[{"name":"Retina Consultants of Texas, Retina Consultants of America, Bellaire, TX 77401, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9605-0742","authenticated-orcid":false,"given":"Gail M.","family":"Teagle","sequence":"additional","affiliation":[{"name":"Retina Consultants of Texas, Retina Consultants of America, Bellaire, TX 77401, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liisa M.","family":"Baumann","sequence":"additional","affiliation":[{"name":"Retina Consultants of Texas, Retina Consultants of America, Bellaire, TX 77401, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8237-6684","authenticated-orcid":false,"given":"Jessica A.","family":"Cao","sequence":"additional","affiliation":[{"name":"Retina Consultants of Texas, Retina Consultants of America, Bellaire, TX 77401, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andres","family":"Emanuelli","sequence":"additional","affiliation":[{"name":"Emanuelli Research and Development Center, Arecibo 00612, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allen Y.","family":"Hu","sequence":"additional","affiliation":[{"name":"Cumberland Valley Retina Consultants, Hagerstown, MD 21740, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam S.","family":"Berger","sequence":"additional","affiliation":[{"name":"Center for Retina and Macular Disease, Clermont, FL 34711, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr.","given":"James C.","family":"Major","sequence":"additional","affiliation":[{"name":"Retina Consultants of Texas, Retina Consultants of America, Bellaire, TX 77401, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seong Y.","family":"Lee","sequence":"additional","affiliation":[{"name":"Strategic Clinical Research Group, Willow Park, TX 76087, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6071-0835","authenticated-orcid":false,"given":"Stephen M.","family":"Huddleston","sequence":"additional","affiliation":[{"name":"Charles Retina Institute, Germantown, TN 38138, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor H.","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Valley Retina Institute, McAllen, TX 78503, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W. Lloyd","family":"Clark","sequence":"additional","affiliation":[{"name":"North Carolina Retina Associates, Retina Consultants of America, Raleigh, NC 27609, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David S.","family":"Liao","sequence":"additional","affiliation":[{"name":"Retina-Vitreous Associates Medical Group, Los Angeles, CA 90017, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6453-4165","authenticated-orcid":false,"given":"Ronald M.","family":"Kingsley","sequence":"additional","affiliation":[{"name":"Dean McGee Eye Institute, Oklahoma City, OK 73104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard S.","family":"Lazarus","sequence":"additional","affiliation":[{"name":"John-Kenyon American Eye Institute, Louisville, KY 40222, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John F.","family":"Payne","sequence":"additional","affiliation":[{"name":"Palmetto Retina Center, Retina Consultants of America, Columbia, SC 29204, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric G.","family":"Feinstein","sequence":"additional","affiliation":[{"name":"Central Florida Retina, Orlando, FL 32806, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6650-9999","authenticated-orcid":false,"given":"Annal D.","family":"Meleth","sequence":"additional","affiliation":[{"name":"Marietta Eye Clinic, Marietta, GA 30060, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5161-0242","authenticated-orcid":false,"given":"Sagar B.","family":"Patel","sequence":"additional","affiliation":[{"name":"Retina Consultants of Texas, Retina Consultants of America, Bellaire, TX 77401, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4453-9337","authenticated-orcid":false,"given":"Kenneth C.","family":"Fan","sequence":"additional","affiliation":[{"name":"Retina Consultants of Texas, Retina Consultants of America, Bellaire, TX 77401, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyson J.","family":"Berliner","sequence":"additional","affiliation":[{"name":"Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hadi","family":"Moini","sequence":"additional","affiliation":[{"name":"Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaomeng","family":"Niu","sequence":"additional","affiliation":[{"name":"Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael S.","family":"Ip","sequence":"additional","affiliation":[{"name":"Doheny Eye Institute, Pasadena, CA 91103, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"SriniVas R.","family":"Sadda","sequence":"additional","affiliation":[{"name":"Doheny Eye Institute, Pasadena, CA 91103, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hasenin","family":"Al-khersan","sequence":"additional","affiliation":[{"name":"Retina Consultants of Texas, Retina Consultants of America, Bellaire, TX 77401, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7756-5091","authenticated-orcid":false,"given":"Charles C.","family":"Wykoff","sequence":"additional","affiliation":[{"name":"Retina Consultants of Texas, Retina Consultants of America, Bellaire, TX 77401, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1001\/jamaophthalmol.2023.2289","article-title":"Prevalence of Diabetic Retinopathy in the US in 2021","volume":"141","author":"Lundeen","year":"2023","journal-title":"JAMA Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Wang, W., and Lo, A.C.Y. 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