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Tara Bryant, Yonwook Justin Kim, Archana Seethala Thangappan, Manju Subramanian; Accelerated Anti-VEGF Dosing for Treatment of Resistant Macular Edema in Patients with Retinal Vein Occlusions. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3672.
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© ARVO (1962-2015); The Authors (2016-present)
Intravitreal therapy has become the gold standard of treatment for cases of macular edema secondary to retinal vein occlusion. There remains a population of patients who show minimal to no improvement in macular edema despite consecutive monthly therapy. For these patients, we have proposed accelerated dosing with alternating anti-vegf injections every two weeks. The primary objective of this study is to examine the clinical outcomes of an accelerated anti-VEGF injection regimen in a select group of patients who have not responded to monthly injections.
This study was approved by the Boston University Institutional Review Board. We performed a retrospective chart review of patients who received bimonthly intravitreal anti-VEGF injections for diabetic macular edema at Boston Medical Center between January 1, 2015 and September 15, 2016. The subjects were selected using the Current Procedural Terminology (CPT) code 67028 for intravitreal injection. Age, sex, ocular comorbidities, indication for injection, site of injection, injected medication, and dates of injection were recorded for each patient. Outcome measures included central foveal thickness and best corrected visual acuity at the start of bimonthly treatments and at the end of bimonthly treatments.
Total of three eyes in three patients were identified to have received bimonthly intravitreal anti-VEGF injections for macular edema secondary to venous occlusion. The average age of patients was 73 (range: 63 - 82). All patients had previously failed the traditional monthly anti-VEGF injection therapy. Patients received and average of 7.3 (range: 2 - 10) injections of alternating bevacizumab and aflibercept every two weeks. The average central foveal thickness before treatment was 404 microns (range: 309 - 455) and 327 microns (range 240 - 456) after treatment. Two eyes had a decrease in central foveal thickness after treatment with accelerated therapy while one patient showed no improvement. Two eyes showed improvement in best corrected visual acuity while one had no improvement.
Patients who show no improvement in macular edema after a series of monthly injections may lose vision permanently if alternate therapies are not attempted. These patients may benefit from alternating antivegf agents, dosed bimonthly with improvement in visual acuity and macular thickness.
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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