Effect of aflibercept on refractory macular edema associated with central retinal vein occlusion

Objective: To report short-term visual and anatomic outcomes of patients who were switched to aflibercept for persistent macular edema associated with central retinal vein occlusion (CRVO). Methods: Retrospective, consecutive, interventional case series of 17 patients with persistent macular edema secondary to CRVO (defined as intraretinal edema and either <50 mu m reduction in central fovea) thickness [CFT] or worsening or no improvement in visual acuity [VA] compared to baseline) despite anti-VEGF treatment who were switched to aflibercept treatment. Main outcome measures included VA, anti-VEGF treatment history, and spectral-domain optical coherence tomography evaluation of macular edema and OFT. Results: The mean age was 77 years, and the mean VA at CRVO diagnosis was 20/135 with a CFT of 523.4 mu m. Mean number of injections before switching to aflibercept was 12.9 (range: 3-40) and mean number of months of anti-VEGF treatment before switching to aflibercept was 18.7. Mean VA at switch to aflibercept was 20/182 (p- 0.50) with mean CFT of 547.9 mu m (p- 0.66). Mean aflibercept injections were 4.0, and mean follow-up from switch to last follow-up was 5.2 months. Final mean VA was 20/115 (p- 0.017), with a CFT of 315.2 mu m (p- 0.0012). Of the patients, 35.2% gained >3 lines. 29% of patients had complete resolution of macular edema, and the mean change in CFT was-233 mu m. Conclusions: Aflibercept appears to have a beneficial effect on anatomic and VA outcomes in a subset of patients with macular edema secondary to CRVO that is refractory to treatment with bevacizumab and/or ranibizumab.