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   Table of Contents      
LETTER TO THE EDITOR
Year : 2015  |  Volume : 63  |  Issue : 5  |  Page : 469-470

Intravitreal ziv-aflibercept for recurrent macular edema secondary to central retinal venous occlusion


Smt. Kanuri Santhamma Retina Vitreous Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India

Date of Web Publication2-Jul-2015

Correspondence Address:
Jay Chhablani
Smt. Kanuri Santhamma Retina Vitreous Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, L. V. Prasad Marg, Banjara Hills, Hyderabad - 500 034, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.159909

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How to cite this article:
Chhablani J. Intravitreal ziv-aflibercept for recurrent macular edema secondary to central retinal venous occlusion. Indian J Ophthalmol 2015;63:469-70

How to cite this URL:
Chhablani J. Intravitreal ziv-aflibercept for recurrent macular edema secondary to central retinal venous occlusion. Indian J Ophthalmol [serial online] 2015 [cited 2017 Nov 20];63:469-70. Available from: http://www.ijo.in/text.asp?2015/63/5/469/159909

Dear Editor,

Recurrent macular edema (ME) secondary to central retinal venous occlusion (CRVO) is a challenging situation. Recently, newer anti-vascular endothelial growth factor (VEGF) drug, aflibercept (Eyelea ® , Bayer Healthcare, Germany), approved by Food and Drug Administration (FDA), has shown good treatment outcomes in randomized clinical trials in patients with ME secondary to CRVO. [1],[2] However, this drug is not available in India. Ziv-aflibercept (Zaltrap; Regeneron, New York, USA), anti-VEGF drug, is a recombinant fusion protein with a similar mechanism to aflibercept. It was approved by FDA in August 2012, for the treatment of resistant metastatic colorectal carcinoma. Recently, Mansour et al. reported intravitreal ziv-aflibercept as safe treatment at 4 weeks without any ocular toxicity in patients with diabetic ME and age-related macular degeneration, and they clarified the concerns about the osmolarity of this preparation. [3],[4] Here, we present a single case of off-label use of intravitreal Zaltrap ® in a patient with recurrent ME secondary to CRVO. Ethics committee approval was taken to report this case.

A 64-year-old male presented with a sudden vision loss in both eyes since 1-month. On examination, his best-corrected visual acuity was 20/160 in right and left eye respectively. He was diagnosed to have CRVO with ME and was treated with intravitreal bevacizumab in both eyes. His systemic investigations were within normal limits. During the follow-up of 20 months, he had multiple episodes of recurrent ME and received 12 and 13 anti-VEGF injections in right and left eye respectively, along with one intravitreal triamcinolone injection and peripheral panretinal photocoagulation in both eyes. After a treatment-free interval of 2 months that is, at 22 months of follow-up, he presented with recurrent edema in both eyes with of 20/200 in both eyes. On examination, there was ME in both eyes, with a central macular thickness (CMT) of 834 μ and 938 μ on optical coherence tomography (OCT) [Figure 1]a and b. In view of recurrent recalcitrant edema, after obtaining informed consent, he underwent intravitreal Zaltrap ® (1.25 mg in 0.05 ml) in both eyes under aseptic conditions, with an interval of 5 days between two eyes. The patient was subsequently followed at postinjection day 1, day 7 and day 30 (1-month). He did not have any symptoms of blurred vision or ocular pain related to injection without any signs of inflammation/toxicity. At 1-month follow-up, his visual acuity improved to 20/100 and 20/159 in his right and left eye respectively. OCT showed a decrease in edema with CMT of 193 μ and 232 μ [Figure 1]c and d in right and left eye respectively. As there was no observed clinical toxicity at 1-month follow-up and good clinical response, the patient has been advised to undergo another injection of Zaltrap ® in both eyes.
Figure 1: Top panel shows severe cystoid macular edema (ME) on spectral domain optical coherence tomography in the right eye (OD) and the left eye (OS) before intravitreal ziv-aflibercept injection. Bottom panel shows significant decrease in ME at 1-month follow-up in both eyes

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This is the first report of intravitreal Zaltrap ® in eyes with ME secondary to CRVO. Our report presents evidence supporting the clinical safety and efficacy of a single intravitreal Zaltrap ® injection and supports its use as the primary or second line of anti-VEGF therapy in recalcitrant ME due to CRVO. However, further studies are warranted to evaluate the long-term safety and efficacy of this drug in various situations where anti-VEGF therapy is indicated.

 
  References Top

1.
Mansour AM, Al-Ghadban SI, Yunis MH, El-Sabban ME. Ziv-aflibercept in macular disease. Br J Ophthalmol 2015, [Epub ahead of print].  Back to cited text no. 1
    
2.
Calugaru D, Calugaru M. Intravitreal aflibercept for macular edema secondary to central retinal vein occlusion: 18-month results of the phase 3 GALILEO study. Am J Ophthalmol 2015;159:607-8.  Back to cited text no. 2
    
3.
Ogura Y, Roider J, Korobelnik JF, Holz FG, Simader C, Schmidt-Erfurth U, et al. Intravitreal aflibercept for macular edema secondary to central retinal vein occlusion: 18-month results of the phase 3 GALILEO study. Am J Ophthalmol 2014;158:1032-8.  Back to cited text no. 3
    
4.
Marmor MF, Martin LJ, Tharpe S. Osmotically induced retinal detachment in the rabbit and primate. Electron miscoscopy of the pigment epithelium. Invest Ophthalmol Vis Sci 1980;19:1016-29.  Back to cited text no. 4
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