Intravitreal aflibercept (Eylea) injection for cystoid macular edema secondary to retinitis pigmentosa - a first case report and short review of the literature

Abstract

BackgroundCystoid macular edema (CME) in retinitis pigmentosa (RP) has been managed in several ways as documented in the literature, with little success, though. The aim of our study was to report for the first time in literature the use of aflibercept in a patient with RP and CME.Case presentationA 52-year-old man presented for blurred vision in his right eye. Best-corrected visual acuity (BCVA) was 3/10 in his right eye and 7/10 in his left eye. Physical examination and appropriate laboratory tests lead to the diagnosis of bilateral RP with CME in the right eye. Retinal thickness in the foveal area of the right eye was 631 μm. The patient was treated with a single intravitreal injection of 0.05 ml/0.5 mg aflibercept. One month later, BCVA of the right eye increased to 4/10, while BCVA of the left eye was unchanged. RT in the right eye decreased to 129 μm. Multifocal electroretinogram response did not improve, yet peaks were better-shaped and no areas of eccentral vision were present. Three and six months after injection, these improvements were maintained.ConclusionThis first-reported case indicates that intravitreal aflibercept injection for addressing CME in RP seems to be an effective treatment.

Retinitis pigmentosa-associated cystoid macular oedema: pathogenesis and avenues of intervention

“…Improvement of CMT and VA following a single unilateral intravitreal injection of aflibercept (Eylea; Regeneron Pharmaceuticals, Tarrytown, New York, USA and Bayer Healthcare Pharmaceuticals, Berlin, Germany) in a patient aged 52 years with RP-CMO was observed and maintained at 6 months 84. We have observed similar responses85 and have commenced a prospective study to determine safety and efficacy of intravitreal aflibercept in RP-CMO (ClinicalTrials.gov identifier NCT02661711).…”

Optical Coherence Tomographic Analysis of Retina in Retinitis Pigmentosa Patients

“…In a clinical study, the results indicated that an intravitreal aflibercept injection was an effective treatment for addressing macular edema in RP patients [88]. However, the level of VEGF was unknown in RP.…”

Dorzolamide in a management of cystoid macular edema in a patient with retinitis pigmentosa sine pigmento

“…This limitation of treatment could be explained by irreparable functional impairment within the fovea, arising from either chronic macular edema or photoreceptor cell dysfunction. Moustafa and Moschos [17] reported only 10% improvement in BCVA after the treatment, despite the significant resolution of macular edema in OCT scan. They deem that reasonable explanation is that CME is only one factor that affects the vision, while atrophy of the retina (particularly of the photoreceptors) also has impact on the visual function.…”

“…The responses to the treatment seem to be individually variable. There are several therapeutic approaches for CME in RP, such as systemic or intravitreal corticosteroids, grid laser photocoagulation, systemic or topical carbonic anhydrase inhibitors [9], and in the recent years some authors found the inhibitors of the vascular endothelial growth factor (VEGF) to be effective [17]. In any case, many practitioners believe that carbonic anhydrase inhibitors are the mainstay of treatment [9].…”