Intravitreal ziv-aflibercept for macular edema following retinal vein occlusion

Paulose, Remya Mareen; Chhablani, Jay; Dedhia, Chintan; Stewart, Michael W.; Mansour, Ahmad M.

doi:10.2147/opth.s116343

Cited by 15 publications

(19 citation statements)

References 24 publications

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“…SD-OCT is widely used in the evaluation of patients with RVO (36)(37)(38)43,45,137,215,264) . SD-OCT allows to examine the integrity of the different retinal layers and to determine overall thickness of the central retina, individual thickness of the retinal layers and the presence of cystic intraretinal edema and subretinal fluid secondary to RVO (36)(37)(38)43,45,137,215,230,264) . SD-…”

Section: B Spectral Domain Optical Coherence Tomography (Sd-oct)mentioning

confidence: 99%

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Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion

Khayat

Williams

Lois

2018

Survey of Ophthalmology

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Retinal vein occlusion (RVO)-including central RVO, branch RVO, and hemicentral and hemispheric RVO-is the second most common vascular cause of visual loss, surpassed only by diabetic retinopathy. The presence and extent of retinal ischemia in RVO is associated with a worse prognosis. On this basis, most previously conducted studies considered ischemic retinal vein occlusion (iRVO) and non-iRVO as separate entities based on set thresholds of existing retinal ischemia as determined by fundus fluorescein angiography. Other diagnostic technologies have been used specifically in the differentiation of ischemic central retinal vein occlusion and nonischemic central retinal vein occlusion. To date, there is no fully accepted definition for iRVO. Some clinicians and researchers may favor establishing a clear differentiation between these forms of RVO; others may prefer not to consider iRVO as a separate entity. Whatever the case, retinal ischemia in RVO confers a higher risk of visual loss and neovascular complications; thus, it should be determined as accurately as possible in patients with this disease and be considered in clinical and experimental studies. Most recently conducted clinical trials evaluating new treatments for macular edema secondary to RVO included none or only few patients with iRVO based on previous definitions (i.e., few patients with sizeable areas of retinal ischemia were recruited in these trials), and thus it is unclear whether the results observed in recruited patients could be extrapolated to those with retinal ischemia. There has been scant research aiming at developing and/or testing treatments for retinal ischemia, as well as to prevent new vessel formation as a result of RVO. We provide a detailed review of the knowledge gathered over the years on iRVO, from controversies on its definition and diagnosis to the understanding of its epidemiology, risk factors and pathogenesis, the structural and functional effects of this disease in the eye and its complications, natural history, and outcomes after treatment. In each section, the definition of iRVO used is given so, independently of whether iRVO is considered a separate clinical entity or a more severe end of the spectrum of RVO, the information will be useful to clinicians to determine patient's risk, guide therapeutic decisions, and counsel patients and for researchers to design future studies.

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Section: B Spectral Domain Optical Coherence Tomography (Sd-oct)mentioning

confidence: 99%

“…Management of iRVO and outcomes following treatment, below). Central subfield thickness (CST) on SD-OCT is commonly used to determine the response to current therapies for macular edema secondary to RVO (36)(37)(38)43,45,137,215,230,264) .…”

Section: B Spectral Domain Optical Coherence Tomography (Sd-oct)mentioning

confidence: 99%

Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion

Khayat

Williams

Lois

2018

Survey of Ophthalmology

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“…11 Similar findings were noted in treatment-resistant patients with BRVO. 12 Currently, there are no reports on the intermediate-term outcomes and safety of ziv-aflibercept in treatment-naïve CRVO, which would be important for further studies investigating a broader use of this agent. We report its use in 6 consecutive patients using a pro re nata (PRN) schedule.…”

Section: Introductionmentioning

confidence: 99%

One-year outcomes of ziv-aflibercept for macular edema in central retinal vein occlusion

Eldeeb

Chan

Dedhia

et al. 2017

American Journal of Ophthalmology Case Reports

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PurposeTo report the 12-month efficacy and safety outcomes of intravitreal ziv-aflibercept in macular edema secondary to central retinal vein occlusion (CRVO).MethodsInterventional case series documenting 12-month outcomes of intravitreal ziv-aflibercept (1.25 mg in 0.05 mL) in 6 patients with treatment-naive macular edema secondary to CRVO. All patients had comprehensive ophthalmic examination, spectral domain optical coherence tomography at baseline and all follow-up visits, and fluorescein. Retreatment decisions were based on recurrence or persistence of intraretinal or subretinal fluid, deterioration in visual acuity (VA), increase in central subfield thickness (CST) by ≥ 50 μm from the previous visit, or lowest recorded CST.ResultsParticipants had (2 males, 4 females) an average age of 53.5 years. From baseline to 12 months, the mean logMAR VA improved from 0.86 (Snellen ≈ 20/145) to 0.33 (Snellen ≈ 20/40), central macular thickness decreased from 519 μm to 255 μm, and total macular volume decreased from 14.7 mm3 to 7.1 mm3. No eyes had uveitis, cataract progression, intraocular pressure (IOP) elevations, or systemic adverse events.Conclusions and importanceZiv-aflibercept achieves favorable intermediate-term functional and structural outcomes in macular edema secondary to CRVO. No safety concerns were raised. Low-cost ziv-aflibercept may thus be useful for CRVO in resource-poor countries. Further prospective studies in larger cohorts are needed further establish the efficacy and safety of this agent.

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“…Ziv-aflibercept is an intravenous formulation approved for the treatment of metastatic colorectal cancer[10] and there are few reports of the safety and efficacy of intravitreally administered off-label intravitreal ziv-aflibercept (IVZ) in patients with BRVO. [111213] IVZ is a similar molecule to IVA with a higher osmolarity in IVZ leading to concerns of intraocular toxicity. [14] A head-to-head comparison of IVA and IVB in treatment naïve BRVO cases with ME showed no significant differences in best corrected visual acuity (BCVA), central macular thickness (CMT), and mean number of injections at 12 months.…”

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confidence: 99%

“…[1617] Few reports have also shown the clinical outcomes of IVZ through 1 year. [1112] However, a comparison between IVB and IVZ has not been reported in the literature.…”

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Bevacizumab versus ziv-aflibercept in branch retinal vein occlusion

Braimah

Singh

Uplanchiwar

et al. 2019

Indian J Ophthalmol

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Purpose: To compare the effectiveness of treatment with intravitreal bevacizumab (IVB) and ziv-aflibercept (IVZ) in patients with macular edema (ME) post-branch retinal vein occlusion (BRVO). Methods: Patients with treatment naïve ME post-BRVO were included retrospectively if they received either IVB (0.05 ml/1.25 mg) or IVZ (0.05 ml/1.25 mg) monotherapy with a follow up of 12 months. Results: Thirty-two and 17 eyes received IVB and IVZ, respectively. The mean improvement in best corrected visual acuity (BCVA) was 0.36 ± 0.3 logarithm of minimum angle of resolution (logMAR) in the IVB group and 0.27 ± 0.3 in the IVZ group ( P = 0.35). The mean change in central macular thickness was 178.9 ± 180.9 and 173.5 ± 344.4 μm in IVB and IVZ groups, respectively ( P = 0.94). The mean number of injections was higher in the IVB group (4.0 ± 1.8) compared with 1.82 ± 0.8 in the IVZ group ( P < 0.0001). The IVZ group had significantly fewer number of visits ( P < 0.0001) and longer maximum treatment-free intervals ( P = 0.0081). Conclusion: IVZ appears to be cost-effective with the similar visual outcome and less number of visits in comparison to IVB.

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Intravitreal ziv-aflibercept for macular edema following retinal vein occlusion

Cited by 15 publications

References 24 publications

Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion

Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion

One-year outcomes of ziv-aflibercept for macular edema in central retinal vein occlusion

Bevacizumab versus ziv-aflibercept in branch retinal vein occlusion

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