Journal of Eye and Ophthalmology ISSN 2055-2408 Case report Open Access Eficacy of alibercept for the treatment of chronic non-ischemic CRVO-associated macular edema after treatment with other anti- VEGF agents Bozho Todorich 1,2* , Phoebe Lin 1,2 , Christine Shieh 1,2 and Sharon Fekrat 1,2 Abstract Objective: To describe a patient with a perfused CRVO that responded to intravitreal alibercept ater prior treatment with intravitreal bevacizumab and intravitreal ranibizumab. Design: Retrospective report of a case. Methods: Institutional retrospective review of a single case of a patient with CRVO-related macular edema treated with anti-VEGF agents (bevacizumab, ranibizumab and alibercept). Baseline demographics, visual acuity and OCT scans are reported. Results: A 62 year old male with a perfused CRVO with marked cystoid macular edema was treated with intravitreal alibercept and subsequently experienced signiicant improvement in visual acuity and central foveal thickness. his efect was observed despite prior treatment with intravitreal bevacizumab as well as intravitreal ranibizumab. Conclusion: Intravitreal alibercept is a viable treatment option for macular edema due to CRVO in eyes even ater prior treatment with other anti-VEGF agents. Keywords: CRVO, bevacizumab, ranibizumab, alibercept, VEGF, macular edema © 2014 Todorich et al; licensee Herbert Publications Ltd. his is an Open Access article distributed under the terms of Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0). his permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction Retinal vein occlusion is a significant cause of visual loss, involving 1% of Americans age 40 and older and affecting 2.5 million people worldwide [1,2]. Central retinal vein occlusion (CRVO) purportedly arises from thrombosis of the vein at the level of the lamina cribrosa [3]. This results in retinal venous congestion producing a constellation of findings including intraretinal edema, disc edema, intraretinal hemorrhages and/or cotton wool spots in all four quadrants of the retina [4,5]. Although CRVO may also produce vision loss through macular ischemia, vitreous hemorrhage or neovascular glaucoma, macular edema represents a major cause of visual loss associated with CRVO [4]. Cystoid macular edema (CME) in CRVO occurs because of leakage of fluid from the retinal perifoveal microvasculature [5]. Furthermore, vascular endothelial growth factor (VEGF) has been identified as a major contributor to the development of CME in CRVO, driving microcapillary permeability through downregulation of capillary tight junctions [6,7]. For several years, the anti-VEGF agents, ranibizumab (Lucentis, Genentech) and bevacizumab (Avastin, Genentech), have been used with success to treat macular edema in eyes with CRVO. A randomized, sham-controlled clinical trial CRUISE (Ranibizumab for the Treatment of Macular Edema After Central Retinal Vein Occlusion Study: Evaluation of Efficacy and Safety) established efficacy of intravitreal ranibizumab for CME in CRVO patients [7]. A smaller, non-randomized prospective study similarly showed the efficacy of bevacizumab for CRVO- related macular edema with improvement in visual acuity and central foveal thickness (CFT) [8]. VEGF Trap-Eye, now known as aflibercept (Eylea, Regeneron Pharmaceuticals), is being assessed in a phase III sham-controlled study (COPERNICUS) for its use in CME related to de novo CRVO, not previously treated with other anti-VEGF agents or laser [9]. The 6-month study results demonstrated better visual and anatomic outcomes in aflibercept-injected eyes compared to sham controls. To our knowledge, there are no published or ongoing studies looking at the efficacy of aflibercept after prior anti-VEGF therapy in CRVO. We report a patient with a chronic non-ischemic CRVO previously treated with intravitreal bevacizumab and ranibizumab who had significant improvement in visual acuity and CFT after receiving a single intravitreal injection of aflibercept. The clinical response demonstrates the benefits of aflibercept for the treatment of chronic CRVO even after treatment with other anti-VEGF agents. Case presentation A 62 year old hypertensive male developed a non-ischemic CRVO with associated CME in his right eye. At the time of initial *Correspondence: btodorich@gmail.com 1 Duke University Eye Center, Erwin Road, PO Box 3802, Durham, NC 27710, USA. 2 Durham Veterans Afairs Medical Center, 508 Fulton Street, Durham, NC 27705, USA. CrossMark ← Click for updates