Intravitreal aflibercept for management of choroidal neovascularization secondary to angioid streaks

Abstract

Purpose To investigate the effect and the safety of intravitreal aflibercept in patients affected by choroidal neovascularization secondary to angioid streaks with a long-term follow-up. Methods Multicentre, open-label, phase IIb study (EYLEA-STRIE, EudraCT Number 2014-000986-30) involving four Italian centres (IRCCS Ospedale San Raffaele (Milano), Fondazione G.B. Bietti (Roma), Policlinico (Milano), Ospedale Luigi Sacco (Milano)). Patients with active choroidal neovascularization secondary to angioid streaks with foveal involvement were prospectively enrolled and followed for 18 months. All the patients received intravitreal 2 mg/0.05 mL aflibercept at the time of enrolment, followed by a pro-re-nata regimen for 48 weeks. Best-corrected visual acuity and central macular thickness were measured monthly. Adverse events were monitored at each visit. Results Twenty-three eyes of 20 patients were analysed. Mean number of injections per patient was 4.30 ± 1.2. At week 48, the best-corrected visual acuity was 0.42 ± 0.40 LogMAR (p = 0.6 from baseline) and 18 eyes (81.8%) featured stability within 15 letters. The central macular thickness significantly reduced (p = 0.03). Eleven ocular non-serious adverse events and two serious adverse events were observed (one case of endophthalmitis and one case of acute gastritis were reported). Conclusion Intravitreal aflibercept represents a valid option for the management of choroidal neovascularization complicating angioid streaks. Further studies with longer follow-up and different therapeutic regimens are warranted to ascertain the best control of the disease.

Intravitreal Brolucizumab for Choroidal Neovascularization Associated to Angioid Streaks

“…Teixeira et al initially reported the use of intravitreal bevacizumab injection in a patient with subfoveal CNV and AS [ 18 ]. Subsequently, the use of the other anti-VEGF molecules, including ranibizumab and aflibercept, has been reported in the literature [ 7 , 8 , 11 , 12 ]. A retrospective series of 35 eyes with CNV secondary to AS treated with ranibizumab was evaluated by Mimoun et al [ 19 ].…”

“…At a mean follow-up of 24.1 months, the authors noted an improvement or stabilization of BCVA in 30 eyes (85.7%), absence of leakage on fundus fluorescein angiography (FFA) in 23 eyes (65.7%), and reduction or stabilization of central macular thickness (CMT) in 18 eyes (51.5%) [ 19 ]. The Italian EYLEA-STRIE study was a multicentre, open-label, phase IIb study evaluating the safety and efficacy of intravitreal aflibercept therapy on a pro-re-nata basis in 23 eyes of 20 patients with CNV secondary to AS [ 11 ]. At 48 weeks, the authors observed an improvement in BCVA with visual stabilization within 15 letters in 81.8% of the eyes and a significant reduction in CMT [ 11 ].…”

“…The Italian EYLEA-STRIE study was a multicentre, open-label, phase IIb study evaluating the safety and efficacy of intravitreal aflibercept therapy on a pro-re-nata basis in 23 eyes of 20 patients with CNV secondary to AS [ 11 ]. At 48 weeks, the authors observed an improvement in BCVA with visual stabilization within 15 letters in 81.8% of the eyes and a significant reduction in CMT [ 11 ]. According to Sekfali et al, switching to aflibercept injection was a good treatment choice for patients with CNV secondary to AS who had resistant or recurrent illness after at least 12 months of ranibizumab therapy [ 20 ].…”

“…According to recent research, the use of antivascular endothelial growth factor (anti-VEGF) therapy is efficacious in the management of CNV secondary to AS [7][8][9][10][11][12]. The use of ranibizumab, bevacizumab, and aflibercept, among the existing anti-VEGF medications, has been documented for treating AS-related CNV [7][8][9][10][11][12].…”

“…According to recent research, the use of antivascular endothelial growth factor (anti-VEGF) therapy is efficacious in the management of CNV secondary to AS [7][8][9][10][11][12]. The use of ranibizumab, bevacizumab, and aflibercept, among the existing anti-VEGF medications, has been documented for treating AS-related CNV [7][8][9][10][11][12]. The most recently FDA-approved treatment for neovascular age-related macular degeneration (nAMD) is the brolucizumab (Beovu ®; Novartis, Basel, Switzerland) molecule [13].…”