Case Studies

Chronic, Persistent Fluid Treated with Aflibercept

By Karl G. Csaky, MD, Dallas, Texas

A 65-year-old male presented with a 6-year history of choroidal neovascularization in the right eye. Initially, he was treated with monthly doses of ranibizumab and had complete resolution of all intra- and subretinal fluid. Once the eye was dry, a treat-and-extend (TAE) approach was used to increase the intervals between injections to every 8-10 weeks. Unfortunately, during the TAE dosing regimen the patient developed chronic persistent fluid and was switched to bevacizumab, with an every-2-weeks alternate dosing strategy. In this subsequent strategy, we alternated between bevacizumab and ranibizumab. and added triamcinolone to both anti-VEGF injections. The patient’s vision remained at 20/80. In February 2012, we switched the patient again, to receive one injection of aflibercept. One month later the patient returned with improvement in visual acuity to the 20/40 level and resolution of both intra- and subretinal fluid. ✦

Figure 1. In the top portion, chronic fluid remains, even after adding a triamcinolone injection. In the bottom portion, however, there is no persistence of fluid in the post-aflibercept eye.