June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Complications, Compliance and 3-Year Outcomes after Endolaserless Vitrectomy with Aflibercept Monotherapy for PDR-Related Vitreous Hemorrhage
Author Affiliations & Notes
  • Venkatkrish Manohar Kasetty
    Ophthalmology, Southeast Retina Center, Augusta, Georgia, United States
    Ophthalmology, Henry Ford Health System Department of Ophthalmology, Detroit, Michigan, United States
  • Davis Starnes
    Ophthalmology, Southeast Retina Center, Augusta, Georgia, United States
  • Heather Frazier
    Ophthalmology, Southeast Retina Center, Augusta, Georgia, United States
  • Harinderjit Singh
    Ophthalmology, Southeast Retina Center, Augusta, Georgia, United States
  • Dennis M Marcus
    Ophthalmology, Southeast Retina Center, Augusta, Georgia, United States
  • Footnotes
    Commercial Relationships   Venkatkrish Kasetty, None; Davis Starnes, None; Heather Frazier, None; Harinderjit Singh, Allegro (F), Allergan (F), Genentech (F), Hoffmann La Roche (F), Ophthotech (F), Regeneron (F); Dennis Marcus, Aerpio Pharmaceuticals (F), Alcon (F), Alimera Sciences (F), Allegro Ophthalmics (F), Allergan (F), Astellas (F), Chenghdu (F), Clearside Biomedical (F), Gemini Therapeutics (F), Genentech/Roche (F), Genentech/Roche (S), Graybug Vision (F), Ionis Pharmaceuticals (F), Iveric bio (F), Kalvista Pharmaceuticals (F), Mylan (F), Novartis (F), Opthea (F), Outlook Therapeutics (F), Pharma (F), Regeneron (F), Regeneron (S), Samsung Bioepis (F), ThromboGenics (F), Tyrogenex, (F)
  • Footnotes
    Support  Regeneron Grant IIRG
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1119. doi:
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      Venkatkrish Manohar Kasetty, Davis Starnes, Heather Frazier, Harinderjit Singh, Dennis M Marcus; Complications, Compliance and 3-Year Outcomes after Endolaserless Vitrectomy with Aflibercept Monotherapy for PDR-Related Vitreous Hemorrhage. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1119.

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

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Abstract

Purpose : To report the 3-year visual and anatomic outcomes, safety, and compliance for patients undergoing endolaserless vitrectomy with intravitreal aflibercept injection (IAI) monotherapy for proliferative diabetic retinopathy (PDR)-related vitreous hemorrhage (VH).

Methods : Eyes underwent endolaserless vitrectomy and received one preoperative and intraoperative IAI followed by randomization to a q8week or q16week IAI group. Additional IAI for PDR progression or DME was administered as needed. Non-compliance was defined as missing >3 consecutive or >6 mandatory appointments. Q8week eyes were evaluated at week 104 for PDR stability and were transitioned to q16week IAI dosing for year 3 if appropriate. Q16week eyes were subject to q8week conversion at any time point if they experienced 2 episodes of recurrent VH.

Results : 31/40 eyes were randomized (14 and 17 eyes in q8week and q16week groups, respectively) with 25/31 (81%) randomized eyes completing 152 weeks. Compliance criteria was met by 10/14 (71%) and 9/17 (53%) eyes in the q8 and q16week groups, respectively. Through 104 weeks, q8 and q16week eyes received an average of 14.4 and 8.8 IAI, respectively. At week 104, 8/14 (57%) q8week eyes were converted to q16week IAI and 3/17 (18%) q16week eyes were converted to q8week IAI. Q8week eyes observed an increase in visual acuity (VA) of 34 letters from 41 to 75 letters (20/160 to 20/32) (p=0.003) compared to an increase of 27 letters from 48 to 75 letters (20/100 to 20/32) in the q16week group (p=0.013). Adverse ocular events in compliant patients included worsening VA > 30 letters at any timepoint (3 q8week eyes, 6 q16week eyes) and VH (2 q8week eyes, 6 q16week eyes). One case of neovascular glaucoma was seen in the q16week group and 1 retinal detachment occurred in both q8 and q16week groups. In addition, recurrent VH was experienced by 1 compliant q8week eye compared to 3 compliant q16weeks eyes.

Conclusions : Endolaserless vitrectomy with aflibercept monotherapy for PDR-related VH has shown to provide significant long-term visual gains. Frequent IAI is required to achieve fewer proliferative consequences. Non-compliance remains a patient-centered issue, further indicating the need for persistent and frequent postoperative anti-VEGF therapy. This data may provide a foundation for evaluating longer acting anti-VEGF treatment modalities with this approach.

This is a 2021 ARVO Annual Meeting abstract.

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