What is the role of aflibercept in the treatment of central retinal vein occlusion (CRVO)?

Updated: Apr 18, 2019
  • Author: Lakshmana M Kooragayala, MD; Chief Editor: Douglas R Lazzaro, MD, FAAO, FACS  more...
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Intravitreal injection of aflibercept

Intravitreal aflibercept (VEGF Trap-Eylea; Regeneron Pharmaceuticals, Inc.) is a fusion protein comprising key domains of human VEGF receptors 1 and 2 with immunoglobulin-G Fc. Intravitreal aflibercept binds multiple isoforms of human VEGF-A and placental growth factor with high affinity.

Two parallel trials, the COPERNICUS and GALILEO studies, evaluated the efficacy and safety of intravitreal aflibercept injection for the treatment of macular edema secondary to CRVO. Aflibercept injection demonstrated a statistically significant difference in the proportion of patients who gained 15 or more letters from baseline at week 24 compared with placebo in each study. The visual and anatomic improvements were diminished after continued PRN dosing, with a reduced monitoring frequency from weeks 52 to 100.

In conclusion, the studies demonstrate that long-term anti-VEGF therapy and more frequent monitoring is necessary to control macular edema in many patients with CRVO, likely because the continued ischemia leads to continued excessive VEGF production. [37, 27, 38, 39, 40]

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