Aflibercept for inflammatory choroidal neovascularization with persistent fluid on intravitreal ranibizumab therapy

Choroidal neovascularization (CNV) is an important cause of severe central vision loss that may appear as a complication of infectious and noninfectious posterior uveitis. Inflammatory CNV is the third cause of CNV after age-related macular degeneration (AMD) and pathologic myopia [1]. The prevalence of inflammatory CNV in eyes with posterior uveitis is about 2 % at the time of initial presentation [2, 3]. Although most cases of inflammatory CNVrespond well to the intravitreal vascular endothelial growth factor (VEGF) inhibitors, bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA, USA) [4-6] and ranibizumab (Lucentis; Genentech, Inc.) [7], there is a proportion of cases that might be suboptimally responders [8]. Several authors have reported the outcomes of switching these VEGF inhibitors to aflibercept (VEGF-TrapEye, Eylea; Regeneron, Tarrytown, NY, USA) for CNV secondary to age-related macular degeneration (AMD) [9, 10]. However, little is known of this switch in indications other than neovascular AMD. Herein, we report the short-term efficacy of intravitreal aflibercept injections in three cases diagnosed with inflammatory CNV and persistent retinal fluid in spite of intravitreal ranibizumab injections.