Effects of Switching to Aflibercept in Treatment Resistant Macular Edema Secondary to Retinal Vein Occlusion

The aim of this study was to examine 12-month outcomes of eyes switched from intravitreal ranibizumab or bevacizumab to aflibercept for cystoid macular edema due to retinal vein occlusion (RVO). DESIGN: Retrospective, observation, case series. METHODS: A retrospective study was performed assessing eyes with RVO switched to aflibercept for at least 12 months. To be included in the study, eyes had to have macular edema despite treatment for at least 6 months with bevacizumab and/or ranibizumab before the switch, central foveal thickness (CFT) ≥300 μm at time of switch, and visual acuity (VA) ≤60 early treatment of diabetic retinopathy score (ETDRS) letters (20/40 Snellen equivalent). Outcome measures included change in VA (in ETDRS letters), CFT, and interval between intravitreal injections. RESULTS: 27 eyes of 27 patients were included in the analysis: 13 with branch RVO, and 14 with central RVO. Mean VA before switch was 54.2 ± 23.7 letters (20/80 Snellen equivalent) and mean CFT was 460.4 ± 178.2 μm. Mean number of previous anti-vascular endothelial growth factor (VEGF) injections was 29.5 ± 19.2. At 12 months, mean VA improved by 8.7 ± 13.2 letters (P < 0.01) and mean CFT decreased by 180.9 ± 207.7 μm compared with baseline (P < 0.01). Mean injection interval increased by 1.6 ± 2.0 weeks to 6.9 ± 1.2 weeks, but this was not statistically significant (P = 0.18). CONCLUSIONS: In our small retrospective study, eyes switched to intravitreal aflibercept for persistent cystoid macular edema (CME) due to RVO improved vision and macular thickness; however, larger prospective studies are required to validate our findings.