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Mohammed Ali Khan, Arman Mashayekhi, Jerry A Shields, Carol L Shields; Intravitreal Aflibercept as Rescue Therapy for Post-Radiation Cystoid Macular Edema. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1292.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the safety and efficacy of intravitreal aflibercept as rescue therapy for persistent post-radiation cystoid macular edema (CME) following prior treatment with intravitreal bevacizumab.<br />
Retrospective, observational, consecutive case series of patients who received intravitreal aflibercept (2mg/0.05mL) for persistent post-radiation CME by the Oncology Service, Wills Eye Hospital (Philadelphia, PA). Primary outcomes were change in central macular thickness (CMT) by optical coherence tomography (OCT) and visual acuity after initiation of intravitreal aflibercept therapy.<br />
Five eyes of five patients with persistent CME following plaque radiotherapy for choroidal malignant melanoma were included. Mean tumor basal diameter was 10.4 mm (range 6 - 16 mm) and mean tumor thickness of 3.56 mm (range 2.2 - 4.7 mm). Mean radiation dose to the macula was 6158 cGy (mean rate to macula 65.5 cGy/hour). OCT evident CME occurred at a mean of 22.8 months (range 8 - 43 months) post plaque radiotherapy. All patients were prior treated with intravitreal bevacizumab (mean 11.6 injections per patient, range 6 - 22 injections). Following treatment with three monthly doses of intravitreal aflibercept, logMar visual acuity improved from mean 0.47 (standard deviation 0.08, Snellen equivalent 20/60) to mean 0.30 (standard deviation 0.24, Snellen equivalent 20/40) (p=0.19). CMT reduced significantly from mean 478.8 microns (standard deviation 123.3) to mean 292.4 microns (standard deviation 46.7)(p=0.01). No patient experienced worsening of CMT or visual acuity while treated with intravitreal aflibercept. No alternative therapies were necessary. No patient experienced an adverse event. At mean final follow-up of 4.2 months (range 3-8 months), mean CMT and logMar visual acuity remained stable at 294.6 microns and 0.35 (Snellen equivalent 20/44), respectively.<br />
Intravitreal aflibercept can be an effective rescue therapy for persistent post-radiation CME in patients with poor response to bevacizumab, with reduction in central macular thickness and improvement in visual acuity.<br />
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