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Daniel Dae Kim, Steven Saraf, Ankit Desai, Uday Desai; The use of aflibercept in the management of macular edema secondary to central retinal vein occlusion. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5332.
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© ARVO (1962-2015); The Authors (2016-present)
Macular edema (ME) is the leading cause of significant visual acuity loss in CRVO. The clinical use of aflibercept, a vascular endothelial growth factor (VEGF) trap-eye, is anecdotally know to be a more effective and longer lasting treatment. We hypothesize that aflibercept has a longer duration of action when compared to other treatments for ME secondary to CRVO.
A retrospective chart review of 23 eyes from 23 patients with ME secondary to CRVO was performed. Treatment for the ME included intravitreal aflibercept, bevacizumab, ranibizumab, triamcinolone, dexamethasone implant, and focal laser. Data included mean visual acuity (Va), central subfield thickness (CST), and intravitreal injection interval. CST data were compared in Stratus to Spectralis equivalents through four different conversion methods. Data was grouped into aflibercept, bevacizumab, and non-aflibercept. Steroids, ranibizumab, and focal laser were not individually analyzed due to sparse data. Groups were compared through a Wilcoxon Signed Rank Test. To test if steroids are a factor in the injection interval increases of aflibercept, groups were reanalyzed with data removed after initiation of steroids.
Although the Va was not found to different among the three groups, the aflibercept group had similar CST vs bevacizumab in 3 or 4 conversion methods, and thinner CST vs non-aflibercept in 3 of 4 conversion methods. The mean injection interval of aflibercept (10.29 weeks) was found to be longer by 4.00 weeks vs bevacizumab (6.28 weeks, P<0.001) and by 2.59 weeks vs non-aflibercept treatments (7.63 weeks, P<0.001). The analysis without steroid data also showed the mean injection interval of aflibercept (10.41 weeks) to be longer by 3.94 weeks vs bevacizumab (6.31 weeks, P<0.005) and by 3.54 weeks vs non-aflibercept treatments (6.52 weeks, P<0.005).
Our study shows that aflibercept compared to bevacizumab and non-aflibercept treatments has comparative efficacy regarding visual acuity and central subfield thickness, but a longer duration of action. Results were similar in both analysis with and without steroid data, suggesting that the longer duration of action is not significantly affected by use of steroids. Should future prospective studies show similar outcomes, it can have considerable clinical impact in the management of ME secondary to CRVO.
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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