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Three-month outcome of ziv-aflibercept for exudative age-related macular degeneration
  1. Ahmad M Mansour1,2,
  2. Jay Chhablani3,
  3. Rafic S Antonios1,
  4. Rohit Yogi3,
  5. Muhammad H Younis1,2,
  6. Rola Dakroub1,2,
  7. Hasan Chahine1
  1. 1Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
  2. 2Department of Ophthalmology, Rafik Hariri University Hospital, Beirut, Lebanon
  3. 3Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
  1. Correspondence to Dr Jay Chhablani, Smt. Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad 500034, Andhra Pradesh, India; jay.chhablani{at}


Purpose In vitro and in vivo studies did not detect toxicity to the retinal pigment epithelium cells using intravitreal ziv-aflibercept. Our purpose is to ascertain the 3-month safety and efficacy in wet age-related macular degeneration (AMD) treated with intravitreal ziv-aflibercept.

Methods Prospectively, consecutive patients with wet AMD underwent ziv-aflibercept intravitreal injection (1.25 mg/0.05 mL) from March 2015 to November 2015. Monitoring of best-corrected visual acuity, intraocular inflammation, cataract progression and by spectral domain optical coherence tomography were carried out at baseline day 1, 1 week, 1 month, 2 months and 3 months after injections.

Results 30 eyes were treated (22 Caucasians, 8 Indians; 16 men, 14 women; 14 right eyes and 16 left eyes) with mean age of 74.3 years with 11 treatment-naïve cases and 19 having had treatment-non-naïve. Best-corrected visual acuity improved from baseline logMAR 1.08–0.74 at 1 week, 0.72 at 1 month, 0.67 at 2 months and 0.71 at 3 months (p<0.001 for all time periods). Central macular thickness in microns decreased from 332.8 to 302.0 at 1 week, 244.8 at 1 month, 229.0 at 2 months and 208.2 at 3 months (p<0.001 for all time periods). There were no signs of intraocular inflammation, or change in lens status or increase in intraocular pressure throughout the study.

Conclusions Off label use of ziv-aflibercept improves visual acuity, without detectable ocular toxicity and offers a cheaper alternative to the same molecule aflibercept, especially in low/middle-income countries and in countries where aflibercept (Eylea) is not available.

Trial registration number NCT02486484.

  • Macula
  • Neovascularisation
  • Retina

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  • Contributors Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data (AMM, JC, RSA, RY, MHY, RD and HC). Drafting the work or revising it critically for important intellectual content (AMM, JC, RSA, RD and HC). Final approval of the version published (AMM, JC, RSA, RY, MHY, RD and HC). Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (AMM and JC).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Local institutional ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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