LETTER TO THE EDITOR

Aflibercept for inflammatory choroidal neovascularizationwith persistent fluid on intravitreal ranibizumab therapy

Pablo Hernández-Martínez & Rosa Dolz-Marco &

Marta Alonso-Plasencia & Rodrigo Abreu-Gonzalez

Received: 17 March 2014 /Revised: 2 April 2014 /Accepted: 4 April 2014# Springer-Verlag Berlin Heidelberg 2014

Dear Editor,Choroidal neovascularization (CNV) is an important cause ofsevere central vision loss that may appear as a complication ofinfectious and noninfectious posterior uveitis. InflammatoryCNV is the third cause of CNV after age-related maculardegeneration (AMD) and pathologic myopia [1]. The preva-lence of inflammatory CNV in eyes with posterior uveitis isabout 2 % at the time of initial presentation [2, 3]. Althoughmost cases of inflammatory CNV respond well to the intravit-real vascular endothelial growth factor (VEGF) inhibitors,bevacizumab (Avastin; Genentech, Inc., South San Francisco,CA, USA) [4–6] and ranibizumab (Lucentis; Genentech, Inc.)[7], there is a proportion of cases that might be suboptimallyresponders [8]. Several authors have reported the outcomes ofswitching these VEGF inhibitors to aflibercept (VEGF-TrapEye, Eylea; Regeneron, Tarrytown, NY, USA) for CNVsecondary to age-related macular degeneration (AMD) [9,10]. However, little is known of this switch in indicationsother than neovascular AMD. Herein, we report the short-term efficacy of intravitreal aflibercept injections in threecases diagnosed with inflammatory CNVand persistent retinalfluid in spite of intravitreal ranibizumab injections.

Case 1

A 30-year-old myopic woman diagnosed of MFC with sec-ondary CNV (Fig. 1a) in her LE received 12 intravitreal

injections of ranibizumab through a follow-up of 732 days.Her mean VA was 0.96, the mean CST measured 284.5 mi-crons, and themean interval between injectionswas 66.5 days.Due to suboptimal anatomical response with persistentintraretinal fluid, therapy was switched to aflibercept. Shereceived four injections of aflibercept through a follow-up of168 days. Her mean VA improved to 1.0 (p=0.317), the meanCST decreased to 266.33 microns (p=0.108), and the meaninterval between injections was 56 days (p=0.109).

Case 2

A 57-year-old myopic woman diagnosed with multifocalchoroiditis (MFC) with secondary CNV in her left eye (LE)(Fig. 1b) had received six injections of ranibizumab through afollow-up of 286 days. Her mean visual acuity (VA) was 0.81,the mean central subfield thickness (CST) measured 295 mi-crons, and the mean interval between injections was 57.2 days.Due to suboptimal anatomical response with persistentintraretinal fluid, intravitreal therapywas switched to aflibercept.She received three injections of aflibercept through a follow-upof 123 days. Her mean VA improved to 0.91 (p=0.399), themean CST decreased to 287.83 microns (p=0.730), and themean interval between injections was 60.3 days (p=0.999).

Case 3

A 21-year-old myopic woman diagnosed of MFC with sec-ondary CNV (Fig. 1c) in her LE had received three intravitrealinjections of ranibizumab through a follow-up of 76 days. Hermean VAwas 0.33, the mean CSTmeasured 233 microns, andthe mean interval between injections was 39.3 days. Due topersistent intraretinal fluid, therapy was switched to aflibercept.She received three injections of aflibercept through a follow-up

P. Hernández-Martínez (*) : R. Dolz-MarcoUnit of Macula, Department of Ophthalmology, University andPolytechnic Hospital La Fe, Spain Polytechnic Hospital La Fe,Bulevar Sur, s/n., 46026 Valencia, Spaine-mail: pablooftalmologia@yahoo.es

M. Alonso-Plasencia : R. Abreu-GonzalezDepartment of Ophthalmology, University Hospital La Candelaria,Tenerife, Spain

Graefes Arch Clin Exp OphthalmolDOI 10.1007/s00417-014-2634-2

of 86 days. Her mean VA improved to 0.45 (p=0.144), themean CST decreased to 201.5 microns (p=0.068), and themean interval between injections was 47 days (p=0.285).Our results show that inflammatory CNV with suboptimalanatomical response to intravitreal ranibizumab therapy andpersistent fluid throughout a long-term follow-up may notsignificantly benefit from switching to intravitreal aflibercept.Further long-term randomized studies are warranted in orderto confirm our results.

Conflict of interest We have no conflict of interest to declare. I havefull access to all data in the study, and I take responsibility for the integrityof the data and accuracy of the data analysis.

All patients signed their informed consent prior to their inclusion inthe study.

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Fig. 1 Multimodal imaging of inflammatory choroidal neovasculariza-tion switched to aflibercept, with enhanced depth imaging optical coher-ence tomography, color photograph and fluorescein angiography. Patient1 (a), female, 30 years old, choroidal neovascularization secondary to

MFC. Patient 2 (b), female, 57 years old, was diagnosed with multifocalchoroiditis (MFC). Patient 3 (c), female, 21 years old, juxtapapillary NVCdue to intermediate uveitis

Graefes Arch Clin Exp Ophthalmol

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