Intravitreal Aflibercept Injection for Macular Edema Due to Central Retinal Vein Occlusion

Comment on ‘The Royal College of Ophthalmologists Guidelines on retinal vein occlusions: executive summary’

“…We read with great interest the legitimate and comprehensive guidelines on retinal vein occlusions (RVO) elaborated by Sivaprasad et al 1 However, the reference data were not updated with the available long-term results of the trials, which had dealt with the efficacy of therapy with ranibizumab (Lucentis, Genentech, Inc., South San Francisco, CA, USA) and aflibercept (Eylea, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA) for macular edema secondary to central RVO (CRVO). [2][3][4] Specifically, the rates of unresolved macular edema were 56% in the RETAIN study, 2 65.7% in the COPERNICUS study, 3 and 39.4% in the GALILEO study, 4 after 51.4, 24, and 18 months of follow-up, respectively. Delayed deterioration in the outcome measures in the mentioned trials could be explained by the lower frequency of injections as well as the long duration of time from CRVO diagnosis to initiation of treatment, during which time patients went without treatment for example, an average of 6.39, 2.73, and 2.6 months in the RETAIN, 2 COPERNICUS, 3 and GALILEO 4 trials, respectively.…”

“…[2][3][4] Specifically, the rates of unresolved macular edema were 56% in the RETAIN study, 2 65.7% in the COPERNICUS study, 3 and 39.4% in the GALILEO study, 4 after 51.4, 24, and 18 months of follow-up, respectively. Delayed deterioration in the outcome measures in the mentioned trials could be explained by the lower frequency of injections as well as the long duration of time from CRVO diagnosis to initiation of treatment, during which time patients went without treatment for example, an average of 6.39, 2.73, and 2.6 months in the RETAIN, 2 COPERNICUS, 3 and GALILEO 4 trials, respectively. These facts favored the delayed occurrence of ischemic and irreversible lesions of the macular ganglion cell complex, close to the foveola, with macular edema being a minor factor.…”

“…1 Ever since the previous guidelines published in 2010 the treatment of RVO in the UK has undergone a rapid evolution, mainly attributed to the recommendation and approval of the use of ranibizumab (Lucentis, Novartis, Basel, Switzerland) and aflibercept (Eylea, Bayer, Berlin, Germany) by The National Institute for Health and Care Excellence (NICE). 2,3 The authors have produced a very clear and comprehensive strategy in stratifying the management plan based on the types of RVO (central vs branch and ischaemic vs non-ischaemic), the visual acuity (46/12 vs 6/12-6/96 vs o6/96), and the presence of macular ischaemia in branch RVO.…”

Central retinal vein occlusion: modifying current treatment protocols

“…17 Visual acuity further dropped at week 100 to reach 13 letters. In addition the number of patients with no fluid on OCT decreased from 74.5 to 34.3%.…”

“…17,18 A summary of the major aflibercept trials as well as a comparison with CRUISE, SCORE, and GENEVA is summarized in Table 2. It can be difficult to compare data between different trials, especially if baseline criteria and primary/secondary end points are different.…”