First Author: C.Gunasekera UK
Co Author(s): B. Bhatia S. Wijetilleka A. Davidson T. Young-Zvandasara A. Ghosh S. Gunasekera J. Patel M. Groppe
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The VIBRANT study demonstrated benefit with aflibercept in branch retinal vein occlusion (BRVO). Aflibercept has only been approved for use in the UK for BRVO since September 2016. Therefore the National Health Service (NHS) has a unique cohort of patients who were exclusively treated with ranibizumab, macular laser or intravitreal steroid for BRVO prior to September 2016. We present a real-world data for patients treated with aflibercept for new and previous BRVO who have received prior treatment with ranibizumab, dexamethasone or macular grid laser in order to determine the efficacy and safety of patients receiving aflibercept in multiple UK hospitals.
Colchester University Hospital NHS Foundation Trust, UK University Hospital of Wales, UK Stoke Mandeville Hospital Buckinghamshire NHS Trust, UK
A retrospective case note review was undertaken for patients treated with aflibercept in branch retinal vein occlusion from September 2016- February 2017 from the three centres. We recorded visual acuity in ETDRS (early treatment diabetic retinopathy study) scores, previous treatments, and prior ranibizumab treatment interval. Optical coherence tomography (OCT) scans were analysed and central retinal thickness was documented.
61 eyes (60 patients) were identified with non-ischaemic BRVO with macular oedema treated with aflibercept. 22 patients had no prior treatment. 33 patients were treated with ranibizumab prior to switching to aflibercept. 21 of these patients were receiving treatment every 4-6 weeks to control disease. Only 1 patient remained on 4 weekly injections whilst the rest were extended to 8 weekly injections. Prior ranibizumab ranged from 3-28 previous injections (mean= 13). Mean visual acuity (VA) at presentation of BRVO was 49.9 ETDRS score (SD 16.1). VA following first aflibercept treatment was 63.9 ETDRS score (SD 13.0) p=0.003 compared to the initial presentation. Mean VA prior to switching to aflibercept was 60.2 ETDRS score improving to 64.3 after the first treatment (p=0.005). Mean central retinal thickness on presentation was 538 microns reducing to 302 microns post treatment (p=0). No cases of endophthalmitis were noted.
These findings show real world data within the NHS with aflibercept and BRVO. Patients receiving aflibercept as primary therapy appreciated a large improvement in vision and improvement in anatomical outcome. Patients resistant to ranibizumab treatment requiring 4 weekly injections are safely able to switch to an 8 weekly regimen with a negligible 3 letter improvement in vision. This could significantly increase capacity in stretched services as 7 visits would be required over a year versus 11. This study would be of interest to ophthalmologists considering switching to aflibercept in BRVO.