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Kaivon Pakzad-Vaezi, Mohammed El-Atfy, Eleni Vrizidou, Peter Addison; Real world clinical audit of aflibercept for management of macular edema secondary to central retinal vein occlusion. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4162.
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© ARVO (1962-2015); The Authors (2016-present)
Landmark multi-center trials (COPERNICUS, GALILEO) demonstrated the efficacy of aflibercept for macular edema secondary to central retinal vein occlusion (CRVO) under controlled circumstances. However, there is a lack of real world clinical data in the United Kingdom and elsewhere in this area. This retrospective, observational clinical study examined aflibercept treatment outcomes in a single center CRVO injection service for comparison to idealized outcomes.
Since June 2015, aflibercept became first-line treatment for macular edema secondary to CRVO at the Moorfields Eye Hospital injection service. All patients between June 1 and December 31, 2015, who had not received any macular edema treatment within the prior 3 months, were analyzed for the following: gain in 15 or more ETDRS letters, total visual gain, decrease in central retinal thickness (CRT) on OCT, proportion achieving dry OCT, and progression to anterior neovascularization. Data was prospectively collected and compared; interim analysis is provided herein.
29 eyes of 28 patients were treated. 9 eyes (31%) were ischemic (>10 disc areas of non-perfusion). Overall, 36% gained 15 or more letters, including 4 of 9 (44%) ischemic eyes. Mean visual gain was 11 letters (range: -12 to +40; standard deviation [SD]: 12). Initial vision in the non-ischemic group was 52 letters (10-85; SD: 19) and 23 letters in the ischemic group (0-64; SD: 24; p<0.005), however both groups gained an average of 11 letters with treatment. Average decrease in CRT was 406 um (81-1077; SD: 311). 58% achieved a dry OCT with treatment. No patients developed anterior or posterior neovascularization during treatment. Sub-group analysis of the 18 treatment naïve patients (13 letter gain [SD: 12]; CRT reduction 462 [SD: 328]) did not show a significant difference in visual gain or CRT reduction compared to previously treated patients (11 letter gain [SD: 12], p=0.44; CRT reduction 327 [SD: 287], p=0.35).
In a real world setting, treatment of macular edema in CRVO with aflibercept compares favorably to clinical trials with idealized circumstances. Visual acuity parameters did not improve to the same degree, while anatomic parameters did. Importantly, the higher proportion of ischemic eyes in this study demonstrated a meaningful improvement in vision, and should not preclude a trial of treatment in clinical practice.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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