Intravitreal aflibercept for macular edema due to central retinal vein occlusion: 5-year results of a real-world study (INTRAMED-CRVO)

Abstract

Purpose: To report the 5-year outcomes of intravitreal aflibercept in patients with macular edema due to central retinal vein occlusion(CRVO).

Methods: Participants in this study were 51 treatment naïve patients with macular edema due to CRVO, who received intravitreal aflibercept 2.0mg using a treat-and-extend regimen after a loading dose of three-monthly injections. The primary outcomes were the mean change in best-corrected visual acuity(BCVA) and central subfield thickness(CST) at month 60 compared to baseline.

Results: At month 60, there was a statistically significant improvement in BCVA with a mean change of 11.5 letters compared to baseline(p<0.001). 19.6% of patients gained ≥15 ETDRS letters compared to baseline. Accordingly, at month 60, there was a statistically significant reduction in CST of about 195 μm compared to baseline(p<0.001). The mean number of injections at month 60 was 23.7. At month 60, about 50% of patients were found to have "good" treatment response, which was associated with ellipsoid zone integrity and the absence of hyperreflective foci on optical coherence tomography. It is worthy to note that 60.8% of patients achieved treatment interval of ≥8 weeks, while 31.4% of patients ≥12 weeks. Factors associated with an extended treatment interval was intact ellipsoid zone, lower baseline CST and the absence of disorganization of inner retinal layers.

Conclusions: At the 5-year follow-up, intravitreal aflibercept showed a mean gain of 11.5 letters in BCVA with an average of 23.7 injections. 31.4% of patients achieved a treatment interval of ≥12 weeks, while about half of patients showed good treatment response.

Keywords: aflibercept; central retinal vein occlusion; optical coherence tomography; treatment; visual acuity.