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  • Aflibercept benefits eyes with poor bevacizumab response for vein occlusion-associated macular edema

    Retina/Vitreous

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    Researchers assessed functional and anatomic outcomes in patients who switched therapy for persistent macular edema due to central (CRVO) or hemiretinal vein occlusion (HRVO).

    Study design

    This secondary analysis of the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) included 49 patients who had CRVO- or HRVO-associated edema and exhibited a poor response to bevacizumab or aflibercept at 6 months. Patients who experienced aflibercept failure (n=14) received a 700-μg dexamethasone implant at 6 months, and if necessary, at month 9, 10 or 11. Eyes originally treated with bevacizumab (n=35) received aflibercept for months 6, 7 and 8, and then shifted to a treat-and-extend aflibercept regimen until month 12.

    The main outcomes were the changes in visual acuity (VA) letter score and central subfield thickness (CST) that occurred between 6 and 12 months.

    Outcomes

    There were no statistically significant improvements in VA or CST in eyes switched to dexamethasone after aflibercept failure. In eyes with a poor response to bevacizumab, aflibercept improved visual acuity by 10.3 letters and reduced CST by 125.4 μm (both P<0.001).

    Limitations

    The study is a post-hoc analysis, lacked control groups and used a small sample size. The results could be explained by regression to the mean.

    Clinical significance

    This study reports an improvement in visual acuity and central subfield thickness in eyes that received an aflibercept intervention after failed bevacizumab therapy in the setting of HRVO and CRVO.