Efficacy of Modified Treat-and-Extend Aflibercept Regimen for Macular Edema Due to Branch Retinal Vein Occlusion: 1-Year Prospective Study.

Yusuke Arai,Shinichi Sakamoto,Yuji Inoue,Hidenori Takahashi,Satoko Tominaga,Satoru Inoda,Hidetoshi Kawashima,Xue Tan,Yasuo Yanagi

doi:10.3390/jcm9082360

Abstract

Purpose: To assess the efficacy and safety of a modified treat-and-extend (mTAE) regimen of aflibercept for macular edema (ME) due to branch retinal vein occlusion (BRVO). Methods: This prospective multicentre intervention study evaluated 50 eyes of 50 patients enrolled from October 2016 to September 2017. The patients received intravitreal aflibercept (IVA) injections on an mTAE regimen for a total of 12 months. The main outcome measures were best-corrected visual acuity (BCVA) and central subfield thickness (CST) at 12 months. Results: The baseline BCVA and CST were 0.33 (0.27) and 488 (171) µm (mean (standard deviation)), respectively. The BCVA and CST were significantly improved at month 12 (0.067 (0.19) LogMAR and 295 (110) µm; both p < 0.0001, paired t-test). The mean number of clinic visits and IVA injections was 6.71 (1.41) and 4.26 (0.71), respectively. The time to first recurrence from the first injection was most frequently 3 months. Conclusion: The mTAE regimen of IVA injections for ME due to BRVO effectively improved BCVA and reduced CST, and thus might be an effective therapy to reduce the number of injections and visits.

Highlights

Branch retinal vein occlusion (BRVO) is a commonly occurring vascular condition of the retina and may lead to significant loss of vision [1,2,3]
Vascular endothelial growth factor (VEGF) is one of the major proteins that is upregulated in BRVO [6], and anti-VEGF therapies have been used as a first-line treatment for macular edema (ME) in eyes with BRVO for the last decade
The BRIGHTER study [9], which reported that ranibizumab with or without adjunct laser treatment was superior to laser treatment alone in improving mean best-corrected visual acuity (BCVA) from the baseline at 6 months, employed a regimen of at least three initial monthly ranibizumab injections until the stabilisation of visual acuity (VA), followed by VA-based pro re nata (PRN) dosing

Summary

Introduction

Branch retinal vein occlusion (BRVO) is a commonly occurring vascular condition of the retina and may lead to significant loss of vision [1,2,3]. Kawamura et al [11] reported a mean Early Treatment Diabetic Retinopathy Study (ETDRS) letters score gain of 15.2 letters and central retinal thickness reduction of 230 μm, with 90% of patients having a Snellen equivalent BCVA of 20/40 or better and 15% having a Snellen equivalent BCVA of 20/20. Such reactive treatment has a potential risk of undertreatment, as has been demonstrated in studies for exudative age-related macular degeneration (AMD)

Methods

Results

Conclusion