Role of aflibercept for macular edema following branch retinal vein occlusion: comparison of clinical trials

Prediction of post-treatment retinal sensitivity by baseline retinal perfusion density measurements in eyes with branch retinal vein occlusion

In this study, we investigated the longitudinal correlation between macular sensitivity and perfusion density (PD) in retinas affected by branch retinal vein occlusion. Retinal sensitivity was measured using microperimetry and PD was measured by optical coherence tomography angiography. We also investigated the possibility that the PD, 1 month after anti-vascular endothelial growth factor (VEGF) treatment, is a predictor of retinal sensitivity after 1 year of successful macular oedema management with anti-VEGF. The correlation between measurements of retinal sensitivity and PD at baseline (1 M) and at 6 and 12 months were investigated. There was a significant positive correlation between retinal sensitivity and PD at all time points (baseline (1 M), r = 0.67, P < 0.0001; 6 months, r = 0.59, P < 0.0001; 12 months, r = 0.62, P < 0.0001) and between the PD at 1 month and retinal sensitivity at 12 months (r = 0.63, P < 0.0001). Unlike in areas that showed a mild to moderate decline in PD, retinal sensitivity in areas where the decrease in PD was severe at baseline did not show significant improvement with treatment over time. These findings suggest that the PD value measured using optical coherence tomography angiography at or soon after the baseline can predict retinal sensitivity after 1 year of anti-VEGF treatment.

Effect of intravitreal aflibercept on corneal endothelial cells: a 6-month follow-up study

Purpose

To determine the effect of intravitreal aflibercept injection on the corneal endothelium in patients with diabetic or cystoid macular edema caused by retinal vein occlusion.

Material and methods

Forty-six eyes of 44 consecutive patients (27 men, 17 women; age range: 55-88 years) were evaluated. All participants initially received a single intravitreal injection of aflibercept (2 mg in 0.05 mL), followed by pro re nata use and underwent central corneal specular microscopy before the injection and at 1, 3 and 6 months after the first injection during a 6-month follow-up period. The endothelial cell density (ECD), average cell size (AVG), standard deviation of cell size (SD), coefficient of variation of cell size (CoV), maximum of cell size (MAX), minimum of cell size (MIN) and percentage of hexagonal cells (Hex%) were analyzed and the central corneal thickness (CCT) was measured.

Results

No significant differences in the ECD, AVG, SD, CoV, MIN, Hex% and CCT were observed between measurements obtained before and 1, 3 and 6 months after the first injection. However, the MAX measured before injection differed significantly from the values measured at 1, 3 and 6 months after the first injection (P=0.033). An average of 1.43±0.58 intravitreal aflibercept injections were administered per patient.

Conclusion

These study findings indicate that the intravitreal administration of aflibercept (2 mg) might very slightly alter the corneal endothelium within 6 months of the first injection.

Intravitreal Injection of Anti-vascular Endothelial Growth Factor Agents for Ocular Vascular Diseases: Clinical Practice Guideline

PURPOSE

To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy.

METHODS

Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations.

RESULTS

All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases.

CONCLUSION

The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients.

Pharmaceutical compounding of aflibercept in prefilled syringes does not affect structural integrity, stability or VEGF and Fc binding properties

Macular edema due to neovascular age-related macular degeneration, diabetes or retinal vein occlusion can cause central vision loss. Intravitreal treatment with antibody-based biopharmaceutical compounds designed to neutralize vascular endothelial growth factor (VEGF) has proven to be an efficient strategy to ameliorate macular edema and restore visual acuity. At the same time, the use of anti-VEGF drugs places an economic burden on the health care system; the drugs are expensive, and repeated injections are usually required to maintain the therapeutic effect. Thus, there is an unmet need for more cost-effective procedures. We here describe how the most recently approved anti-VEGF drug, aflibercept, can be compounded into prefilled sterile syringes and stored for up to 4 weeks without compromising its quality, stability or functional properties, including VEGF and neonatal Fc receptor (FcRn) binding. The novel compounding method for repackaging of aflibercept in sterile plastic syringes can greatly reduce both cost and time spent per patient in the injection room.