Abstract
Purpose :
Central retinal vein occlusion (CRVO) results from thrombosis of the central retinal vein when it passes through the lamina cribrosa. Macular edema (MO) is the most common cause of visual impairment in CRVO. Intravitreal vascular endothelial growth factor (VEGF) inhibitors are the mainstay for the management of MO due to CRVO. Aflibercept may have a higher affinity to VEGF-A and could maintain intravitreal VEGF binding for a longer period than ranibizumab. Aim of this study is to compare the real life results of treat and extend Aflibercept in the treatment of MO due to CRVO with the published data.
Methods :
This is a retrospective analysis of treatment naïve patients with macular edema due to CRVO that received Aflibercept injections in a treat and extend regime in a clinical setting. According to protocol patients received 3 injections at monthly intervals.
Monthly injections continued until visual acuity plateaued and the OCT was dry, at which point the interval was extended to 8 weeks. The interval between each injection was increased according to response following a treat-and-extend protocol, extending by 2-4 weeks each time the OCT is dry, up to a maximum of 12 weeks. During the extension phase, if fluid recurred the interval was brought back to the previous interval at which the OCT was dry.
Results :
This cohort includes 245 treatment naïve patients with MO secondary to CRVO that presented in one clinical setting from January 2017 and the subsequent 18 months.
The mean visual acuity (VA) at presentation was 50.07 EDTRS letters (Min: 5, Max: 89). After a mean of 7 injections (Min: 1, Max: 42) the VA improved at a mean of 60.02 EDTRS letters (Min: 5, Max: 90) on the day of last injection.
The mean follow up was 227.00 days (Min: 0, Max: 651).
Conclusions :
Real life data suggest that aflibercept at a treat and extend regime is effective in the treatment of MO secondary to CRVO, requiring fewer intravitreal injections and thus reducing the treatment burden and the need for close monitoring of patients.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.