Intravitreal Aflibercept as Rescue Therapy for Post-Radiation Cystoid Macular Edema Resistant to Intravitreal Bevacizumab: Outcomes at 1 Year

Abstract

Background/Aims: To investigate the efficacy of intravitreal aflibercept as rescue therapy for post-radiation cystoid macular edema (CME) resistant to prior treatment with intravitreal bevacizumab (IVB). Methods: Retrospective, interventional, case-controlled series. Eyes with persistent post-radiation CME were treated with intravitreal aflibercept (2 mg/0.05 mL). Central macular thickness (CMT) and visual acuity were compared to a matched control group treated with only IVB at 1 year. Results: Ten eyes of 10 patients were included, with 5 eyes in the intervention and 5 in the control group. The eyes in the intervention group had previously been treated with IVB (mean 11.6 injections, range 6-22) but failed to show resolution of CME. Following rescue treatment with a mean of 9 injections of aflibercept, the mean CMT was reduced from 463 ± 138 to 267 ± 80 μm (p = 0.02) and the mean Snellen visual acuity was improved from 20/67 to 20/42 (p = 0.03). At 1 year, the eyes in the intervention group had lower CMT (267 ± 80 vs. 361 ± 71 μm, p = 0.09) and significantly better Snellen visual acuity (20/48 vs. 20/76, p = 0.02) compared to the control group. Conclusions: Aflibercept may be an effective rescue therapy for persistent post-radiation CME in eyes with incomplete response to IVB, with reduction in CMT and improvement in visual acuity.