Intravitreal Aflibercept as Rescue Therapy for Post-Radiation Cystoid Macular Edema Resistant to Intravitreal Bevacizumab: Outcomes at 1 Year

Abstract

Background/Aims: To investigate the efficacy of intravitreal aflibercept as rescue therapy for post-radiation cystoid macular edema (CME) resistant to prior treatment with intravitreal bevacizumab (IVB). Methods: Retrospective, interventional, case-controlled series. Eyes with persistent post-radiation CME were treated with intravitreal aflibercept (2 mg/0.05 mL). Central macular thickness (CMT) and visual acuity were compared to a matched control group treated with only IVB at 1 year. Results: Ten eyes of 10 patients were included, with 5 eyes in the intervention and 5 in the control group. The eyes in the intervention group had previously been treated with IVB (mean 11.6 injections, range 6-22) but failed to show resolution of CME. Following rescue treatment with a mean of 9 injections of aflibercept, the mean CMT was reduced from 463 ± 138 to 267 ± 80 μm (p = 0.02) and the mean Snellen visual acuity was improved from 20/67 to 20/42 (p = 0.03). At 1 year, the eyes in the intervention group had lower CMT (267 ± 80 vs. 361 ± 71 μm, p = 0.09) and significantly better Snellen visual acuity (20/48 vs. 20/76, p = 0.02) compared to the control group. Conclusions: Aflibercept may be an effective rescue therapy for persistent post-radiation CME in eyes with incomplete response to IVB, with reduction in CMT and improvement in visual acuity.

Intravitreal aflibercept combined with transpupillary thermotherapy in the treatment of refractory macular edema due to primary uveal melanoma

“…Aflibercept (Eylea; Regeneron Pharmaceuticals, Inc, Tarrytown, NY, USA) is another anti-VEGF agent, which has revealed promising effect in cases of bevacizumab-resistant postradiation cystoid macular edema (CME). [ 5 ] Thus, here, we present a case of primary uveal melanoma with bevacizumab-resistant CME and demonstrate the role of aflibercept as a potential therapy.…”

Aflibercept for Radiation Maculopathy (ARM Study): Year-2 Extension of a Prospective Clinical Study

“…With newer understanding of the early presentation of radiation retinopathy and the impact it may have on anatomic and visual outcome, many investigators have more recently begun earlier treatments including laser photocoagulation, intravitreal steroids, and/or intravitreal anti-VEGFs. 4,5,23,[28][29][30][31][32][33] Advanced imaging of postradiation-treated eyes has advanced our understanding of radiation maculopathy. The ability to detect early, clinically significant macular edema was enhanced with SD-OCT and swept-source OCT.…”

“…In our center, best-care practices for patients unresponsive to short-course bevacizumab were to transition to treatment with intravitreal triamcinolone acetonide in a combined approach. 31 Multiple investigators have noted marked improvement in retinal anatomy but reported variable improvements in VA. 32,33 Virtually all of these reports were retrospective and nonstandardized, but the increasing recognition of improved outcomes has slowly led to the incorporation of intravitreal injection therapy from a small handful of ocular oncology centers to virtually all centers in the United States.…”

“…With newer understanding of the early presentation of radiation retinopathy and the impact it may have on anatomic and visual outcome, many investigators have more recently begun earlier treatments including laser photocoagulation, intravitreal steroids, and/or intravitreal anti-VEGFs. 4,5,23,28 -33…”

<p>Disaster Preparedness Impact In A Complex Ophthalmology Practice: A Review Of Patients Receiving Intravitreal Injections</p>

“…3,4 Intravitreal injection therapy has shown to keep visual acuity and macular anatomy stable in several studies. [5][6][7] Additionally, appropriate treatment modality regarding injection intervals prior to the hurricane may have aided in improving outcomes despite the delay in therapy.…”