Intravitreal Aflibercept Injection and Photodynamic Treatment of a Patient with Unilateral Subretinal Neovascular Membrane Associated with Fundus Flavimaculatus

Abstract

We report the good outcome of combined intravitreal aflibercept injection and photodynamic treatment in a case with fundus flavimaculatus (FFM) and unilateral subretinal neovascular membrane (SRNM). A 57-year-old man with FFM and unilateral SRNM who was treated with two consecutive ranibizumab injections with no improvement at another institution was referred to us. He was treated successfully with three aflibercept injections three months apart and a single photodynamic treatment performed a week after the initial aflibercept injection. Six weeks after the last aflibercept injection visual acuity was improved and submacular exudation exhibited dramatic resolution with a moderate degree of residual scarring. SRNM formation is rarely observed in eyes with FFM and a satisfactory outcome can be achieved with a proper treatment.

Clinical outcomes of treated macular neovascularisation secondary to inherited retinal diseases: a literature review

“…The authors stated that the inflammatory component may have been a random association or indeed suggests a role of inflammatory pathways in Stargardt-like diseases. 95 In another case of FFM, three 3-monthly intravitreal injections of aflibercept in combination with PDT showed resolution of CNV with scarring, but no significant improvement in the VA. 96 …”

Long-Term Efficacy of Intravitreal Anti-VEGF Therapy for Choroidal Neovascularization in a Case of Fundus Flavimaculatus (FFM)

“…A standard treatment for CNV associated with FFM has not been established so far. Explored therapies have been mainly focused on the application of PDT and intravitreal anti-VEGF injections 4 , 6 , 7 , 8 . To our knowledge, only short-term therapeutic outcomes have been described.…”

“…Intravitreal anti-VEGF injections either as monotherapy or combined with PDT have been suggested by several authors 8 , 10 . In a case reported by Saatci et al 8 , a satisfying outcome of intravitreal aflibercept combined with PDT resulted in a satisfying short-term outcome. Successful short-term observations were reported on the use of intravitreal ranibizumab by several authors 7 , 10 , 11 .…”

“…Earlier reports referred to successful treatment options that focused on PDT, however, the patientsʼ follow-up covered in these reports only relatively short periods of time [5]. Later reports demonstrated poor efficacy of PDT alone [9] and introduced combination therapies [8,9]. Some therapeutic efficacy has been shown through the combination of PDT with triamcinolone, which managed to stop the leakage of CNV, but, unfortunately, was accompanied with a relatively poor visual outcome [9].…”

“…Some therapeutic efficacy has been shown through the combination of PDT with triamcinolone, which managed to stop the leakage of CNV, but, unfortunately, was accompanied with a relatively poor visual outcome [9]. Intravitreal anti-VEGF injections either as monotherapy or combined with PDT have been suggested by several authors [8,10]. In a case reported by Saatci et al [8], a satisfying outcome of intravitreal aflibercept combined with PDT resulted in a satisfying short-term outcome.…”