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Long-term safety and efficacy of ziv-aflibercept in retinal diseases
  1. Ahmad M Mansour1,2,
  2. Mohammed Ashraf3,
  3. Chintan J Dedhia4,
  4. Abdulrazzak Charbaji5,6,
  5. Ahmed A R Souka3,
  6. Jay Chhablani4
    1. 1Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
    2. 2Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon
    3. 3Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
    4. 4Smt. Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
    5. 5Department of Statistics and Research Methodology, Lebanese American University, Beirut, Lebanon
    6. 6Department of Statistics and Research Methodology, Lebanese University, Beirut, Lebanon
    1. Correspondence to Dr Jay Chhablani, Smt. Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Banjara Hills, Hyderabad, AP 500034, India; jay.chhablani{at}


    Aims To investigate the long-term safety of intravitreal ziv-aflibercept in eyes receiving six or more intravitreal injections of ziv-aflibercept, an off-label substitute to the approved aflibercept.

    Methods Consecutive patients with retinal disease receiving six or more of intravitreal 0.05 mL ziv-aflibercept (1.25 mg) injections were followed monthly in three centres. Outcome measures were best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution (logMar)) and central macular thickness (CMT) on spectral domain optical coherence tomography and monitoring for ocular inflammation, progression of lens opacities and intraocular pressure rise. Paired comparison was done using Wilcoxon signed-rank test calculator.

    Results Sixty-five eyes of 60 consecutive patients received a mean of 8.4 (6–17) intravitreal injections with a baseline mean logMAR BCVA of 0.98±0.56 and CMT 432.7±163.0 μm and followed for a mean of 9.2 months (range 6–18 months). After the sixth injection, mean BCVA improved to 0.57±0.36 (p=0.001) and CMT decreased to 274.8±117.8 μm (p=0.0001). At the 9-month follow-up, mean BCVA improved to 0.62±0.37 (p=0.0004) and mean CMT decreased to 292.0±160.9 μm (p<0.01) in 19 eyes. At 1 year, mean BCVA was 0.73±0.52 and CMT 311.6±232.5 μm in seven eyes. Intraocular pressures did not increase after injections. One subject developed transient mild iritis at the fourth injection but not on subsequent injections. No lens opacity progression or endophthalmitis was noted. Systemic adverse effects were not registered.

    Conclusions Repeated intravitreal injections of ziv-aflibercept appear tolerable, safe and efficacious in the therapy of retinal disease.

    • Retina

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    • Twitter Follow Ahmed Souka @ahmedsouka

    • Collaborators ‘Ziv-aflibercept study group’ investigators: Rajeev Reddy Pappuru, Taraprasad Das, Padmaja Kumari Rani, Mudit Tyagi, Raja Narayanan, Vivek Dave, Subhadra Jalali, Divya Balakrishnan, Muchai Gachago, Bhushan Uplanchiwar, Kushal Agrawal, Hitesh Agrawal, Remya Paulose, Mahima Jhingan, Vishal Govindhari, Sumit Randhir Singh, Rushil Kumar and Komal Agrawal.

    • Contributors AMM and JC: design and CD, AMM, MA, JC, AC and AARS: conduct of the study. CD, AMM, MA, JC, AC and AARS: collection, JC, AMM and CD: management, AMM: analysis and AMM JC and MA: interpretation of the data. AMM, JC and AARS: preparation, CD, AMM, MA, JC, AC and AARS: review and CD, AMM, MA, JC, AC and AARS: approval of the manuscript.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval L V Prasad Eye Institute Ethics Committee.

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