Effect of Aflibercept on Cystoid Macular Edema Associated with Central Retinal Vein Occlusion. Results from a District Hospital in the United Kingdom

Abstract

Purpose The purpose of this study was to report the efficiency and safety of intravitreal aflibercept for the treatment of cystoid macular edema (CME) secondary to central retinal vein occlusion (CRVO).

Methods This is a retrospective cohort study. Ten naive eyes of ten patients with CME secondary to CRVO were included. All eyes received a loading dose of 3 monthly aflibercept injections followed by as-needed injections at monthly follow-up visits. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were evaluated at baseline and at the end of the follow-up period.

Results The median follow-up period was 6 months (range: 6 – 9). The median number of injections was 4 (range: 3 – 5). Median BCVA improved from 1.05 LogMAR units (range: 0.7 – 1.6) at baseline to 0.65 (range: 0.4 – 1.6) at the end of the follow-up period (p = 0.02). Median CRT improved from 690 µm (range: 561 – 1235) at baseline to 243 µm (range: 207 – 531) at the end of the follow-up period (p = 0.002). The power of all statistical tests was greater than 0.8. No adverse effects or complications were documented.

Conclusion Intravitreal aflibercept treatment for CME secondary to CRVO significantly improved both macular anatomy and visual acuity without adverse effects.

Zusammenfassung

Ziel Prüfung der Effizienz und Sicherheit von intravitrealer Gabe von Aflibercept bei zystoidem Makulaödem (CMO) nach Zentralvenenverschluss (CRVO).

Methode Es handelt sich dabei um eine retrospektive Kohortenstudie. Zehn Augen von 10 Patienten mit CMO bei Zustand nach CRVO wurden untersucht. Alle Augen bekamen eine Initialdosis von 3 Aflibercept-Injektionen monatlich, mit weiteren monatlichen Injektionen nach Bedarf im Rahmen der Beobachtungsperiode. Die bestkorrigierte Sehschärfe (BCVA) und die zentrale Netzhautdicke (CRT) wurden präoperativ („Baseline“) und bei der letzten Nachkontrolle postoperativ („end of the follow-up period“) überprüft.

Befunde Der Median der Beobachtungszeit betrug 6 Monate (3 – 9). Der Median der Anzahl von Injektionen war 4 (3 – 5). Der Median der BCVA hat sich von 1,05 (0,7 – 1,6) LogMAR-Einheiten präoperativ auf 0,65 (0,4 – 1,6) am Ende der Beobachtungszeit (p = 0,02) verbessert. Die durchschnittliche CRT stieg von 690 µm (561 – 1235 µm) präoperativ auf 243 µm (Spektrum 207 – 531 µm) am Ende der Nachbeobachtungszeit an (p = 0,002). Die statistische Aussagekraft aller Tests war größer als 0,8. Es wurden keine Nebenwirkungen oder Komplikationen dokumentiert.

Schlussfolgerung Intravitreale Aflibercept-Therapie verbesserte signifikant sowohl die zentrale Netzhautdicke als auch den Visus der Patienten mit CMO bei Zustand nach CRVO, ohne Komplikationen.

Key words

central retinal vein occlusion - aflibercept - Eylea - anti-VEGF - intravitreal injections - macular edema

Schlüsselwörter

Zentralvenenverschluss - Aflibercept - Eylea - anti-VEGF - intravitreale Injektionen - Makulaödem

• References

• 1 McIntosh RL, Rogers SL, Lim L. et al. Natural history of central retinal vein occlusion: an evidence-based systematic review. Ophthalmology 2010; 117: 1113-1123
• 2 Wong TY, Scott IU. Clinical practice. Retinal-vein occlusion. N Engl J Med 2010; 363: 2135-2144
• 3 Miller JW, Le Couter J, Strauss EC. et al. Vascular endothelial growth factor a in intraocular vascular disease. Ophthalmology 2013; 120: 106-114
• 4 Noma H, Funatsu H, Mimura T. et al. Role of soluble vascular endothelial growth factor receptor-2 in macular oedema with central retinal vein occlusion. Br J Ophthalmol 2011; 95: 788-792
• 5 Ip M, Hendrick A. Retinal vein occlusion review. Asia Pac J Ophthalmol (Phila) 2018; 7: 40-45
• 6 Panos GD. Evolution of intravitreal therapy for retinal and macular disorders. J Int Med Res 2018;
• 7 Bansal R, Bansal P, Kulkarni P. et al. Wandering Ozurdex(^®) implant. J Ophthalmic Inflamm Infect 2012; 2: 1-5
• 8 Haller JA, Bandello F, Belfort jr. R. et al. Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology 2010; 117: 1134-1146
• 9 Brown DM, Campochiaro PA, Singh RP. et al. Ranibizumab for macular edema following central retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology 2010; 117: 1124-1133
• 10 Heier JS, Campochiaro PA, Yau L. et al. Ranibizumab for macular edema due to retinal vein occlusions: long-term follow-up in the HORIZON trial. Ophthalmology 2012; 119: 802-809
• 11 Heier JS, Clark WL, Boyer DS. et al. Intravitreal aflibercept injection for macular edema due to central retinal vein occlusion: two-year results from the COPERNICUS study. Ophthalmology 2014; 121: 1414-1420
• 12 Ogura Y, Roider J, Korobelnik JF. et al. Intravitreal aflibercept for macular edema secondary to central retinal vein occlusion: 18-month results of the phase 3 GALILEO study. Am J Ophthalmol 2014; 158: 1032-1038
• 13 Triantafylla M, Massa HF, Dardabounis D. et al. Ranibizumab for the treatment of degenerative ocular conditions. Clin Ophthalmol 2014; 8: 1187-1198
• 14 Papakostas TD, Lim L, van Zyl T. et al. Intravitreal aflibercept for macular oedema secondary to central retinal vein occlusion in patients with prior treatment with bevacizumab or ranibizumab. Eye (Lond) 2016; 30: 79-84
• 15 Cohen MN, Houston SK, Juhn A. et al. Effect of aflibercept on refractory macular edema associated with central retinal vein occlusion. Can J Ophthalmol 2016; 51: 342-347
• 16 Eldeeb M, Chan EW, Dedhia CJ. et al. One-year outcomes of ziv-aflibercept for macular edema in central retinal vein occlusion. Am J Ophthalmol Case Rep 2017; 8: 58-61
• 17 Casselholm de Salles M, Amren U, Kvanta A. et al. Injection frequency of aflibercept versus ranibizumab in a treat-and-extend regimen for central vein occlusion: a randomized clinical trial. Retina 2018;