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   Table of Contents      
LETTER TO THE EDITOR
Year : 2015  |  Volume : 63  |  Issue : 9  |  Page : 751

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


Department of Retina, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India

Date of Web Publication3-Dec-2015

Correspondence Address:
Dr. Alok Sen
Department of Retina, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.170982

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How to cite this article:
Sen A, Mitra A, Malhotra PP, Gupta S. Comment on: Intravitreal ziv-aflibercept for recurrent macular edema secondary to central retinal venous occlusion. Indian J Ophthalmol 2015;63:751

How to cite this URL:
Sen A, Mitra A, Malhotra PP, Gupta S. Comment on: Intravitreal ziv-aflibercept for recurrent macular edema secondary to central retinal venous occlusion. Indian J Ophthalmol [serial online] 2015 [cited 2020 Jun 2];63:751. Available from: http://www.ijo.in/text.asp?2015/63/9/751/170982

Dear Sir,

We read with great interest the letter entitled, “Intravitreal ziv-aflibercept for recurrent macular edema (ME) secondary to central retinal venous occlusion” by Chhablani published in Journal’s May issue.[1]

The author did take an honest and scientific approach in administering and thereafter reporting the use of intravitreal Zaltrap® (ziv-aflibercept) in the eyes with ME secondary to central retinal vein occlusion (CRVO) for the 1st time. This certainly adds to the emerging evidence of the use of ziv-aflibercept in the management of various retinal disorders.

However, we would like to make the following submissions.

The current literature on the use of ziv-aflibercept does not provide any detail about its long-term cumulative effect and safety profile.[2],[3] We feel that it would have been safer to use the drug in one of the eyes to see for its effect or side effects before considering it in the other eye.

The author stated that the patient’s visual acuity at presentation, i.e., 2 years back was 20/160; before administering ziv-aflibercept, it was 20/200 in both the eyes; and at 1-month follow-up, it had improved to 20/100 in both eyes. However, the visual acuity during the treatment-free period has not been mentioned. We would like to know whether the response to ziv-aflibercept was similar to or better than that following injection with bevacizumab.

The binding activity of 2 mg VEGF trap-eye, i.e., aflibercept at 83 days is estimated to be comparable to the activity of 0.5 mg ranibizumab at 30 days, and similar is expected for ziv-aflibercept.[4]

As this was a case of recurrent ME and not persistent edema, it would be interesting to know whether the new intervention prolonged disease free interval.

The author rightly accepted that further studies are warranted to evaluate the long-term safety and efficacy of this drug in other situations where anti-VEGF therapy is indicated. We also strongly feel that we need to be patient and wait until better evidence on its safety and efficacy are published before considering routine use of ziv-aflibercept as the second or first line therapy for ME due to CRVO.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Chhablani J. Intravitreal ziv-aflibercept for recurrent macular edema secondary to central retinal venous occlusion. Indian J Ophthalmol 2015;63:469-70.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Mansour AM, Al-Ghadban SI, Yunis MH, El-Sabban ME. Ziv-aflibercept in macular disease. Br J Ophthalmol 2015;99:1055-9.  Back to cited text no. 2
    
3.
de Oliveira Dias JR, Xavier CO, Maia A, de Moraes NS, Meyer C, Farah ME, et al. Intravitreal injection of ziv-aflibercept in patient with refractory age-related macular degeneration. Ophthalmic Surg Lasers Imaging Retina 2015;46:91-4.  Back to cited text no. 3
[PUBMED]    
4.
Stewart MW, Rosenfeld PJ. Predicted biological activity of intravitreal VEGF Trap. Br J Ophthalmol 2008;92:667-8.  Back to cited text no. 4
    




 

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