June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Real life experience of combined fixed-dosing and Treat and Extend protocols for intravitreal Aflibercept injections for Macular Oedema secondary to Central Retinal Vein Occlusion (CRVO)
Author Affiliations & Notes
  • Caspar Geenen
    Ophthalmology, City Hospitals Sunderland NHS Foundation Trust, Durham, United Kingdom
  • Karim El-Assal
    Ophthalmology, City Hospitals Sunderland NHS Foundation Trust, Durham, United Kingdom
  • David Steel
    Ophthalmology, City Hospitals Sunderland NHS Foundation Trust, Durham, United Kingdom
  • Deepali Varma
    Ophthalmology, City Hospitals Sunderland NHS Foundation Trust, Durham, United Kingdom
  • Ajay Kotagiri
    Ophthalmology, City Hospitals Sunderland NHS Foundation Trust, Durham, United Kingdom
  • Jonathan Smith
    Ophthalmology, City Hospitals Sunderland NHS Foundation Trust, Durham, United Kingdom
  • Maria T Sandinha
    Ophthalmology, City Hospitals Sunderland NHS Foundation Trust, Durham, United Kingdom
  • Maged S Habib
    Ophthalmology, City Hospitals Sunderland NHS Foundation Trust, Durham, United Kingdom
  • Footnotes
    Commercial Relationships   Caspar Geenen, None; Karim El-Assal, None; David Steel, None; Deepali Varma, None; Ajay Kotagiri, None; Jonathan Smith, None; Maria Sandinha, None; Maged Habib, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 3649. doi:
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      Caspar Geenen, Karim El-Assal, David Steel, Deepali Varma, Ajay Kotagiri, Jonathan Smith, Maria T Sandinha, Maged S Habib; Real life experience of combined fixed-dosing and Treat and Extend protocols for intravitreal Aflibercept injections for Macular Oedema secondary to Central Retinal Vein Occlusion (CRVO). Invest. Ophthalmol. Vis. Sci. 2017;58(8):3649.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Clinical Trials have demonstrated the efficacy and safety of intravitreal aflibercept for treatment of macular oedema (MO) secondary to CRVO. In clinical practice, several treatment protocols have been adopted for timely delivery of the drug to achieve better outcomes.
In this retrospective audit, we evaluated the functional and structural outcomes of intravitreal aflibercept by adopting a modified mixed protocol of fixed dosing (FD) with treat and extend (T&E) following initial loading doses in patients with MO secondary to CRVO.

Methods : Retrospective data was collected for treatment-naive patients with MO secondary to CRVO initiating treatment with aflibercept between March 2015 and March 2016.
All patients received 5 initial monthly loading doses, followed by clinical assessment. Further management was planned based upon their initial response. Stable patients (Best Corrected Visual Acuity BCVA more than 5 letters gain or more than 15% decrease in baseline Central Macular Thickness CMT) received a batch of two 2-monthly injections, then were reassessed. Unstable patients (BCVA less than 5 letters gain from baseline and less than 15% decrease of baseline CMT) received a batch of 3 further injections on 4 – 6 weekly intervals before reassessment. Resolved patients (BCVA more than 5 letters gain and dry macula) were extended to 3-monthly injections and monitored thereafter.
Demographic and clinical data were recorded, and the number of injections. BCVA was recorded with the ETDRS visual acuity score chart and CMT using Heidelberg Spectralis.

Results : 35 eyes of 33 patients were included. Mean age was 74.6 years (SD 11.8), 57% were males.
Baseline BCVA was 37.7 letters (SD 21.4), while baseline CMT was 702.1 (SD 215.9). At month 6, BCVA improved to 50.6 letters (SD 25.1).
At 12 months, mean BCVA further improved to 58.1 letters (SD 21.1) with mean CMT of 379 (SD 181.1). Patients received an average of 8 injections in the first year.

Conclusions : Our results demonstrate that in clinical practice, initial BCVA gains can be maintained and improved at one year by adopting a modified mixed FD and T&E approach. Our results are in keeping with published clinical trial results.
The new protocols have the benefit of timely delivery of predetermined scheduled treatments and reducing the burden on clinic capacity.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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