Management of Macular Edema Secondary to Branch Retinal Vein Occlusion in an Eye with Prior Vitrectomy and Lensectomy

An 82-year-old male with a history of pars plana vitrectomy and lensectomy 6 years before presented with symptomatic macular edema (ME) from superotemporal branch retinal vein occlusion. He was sequentially treated with intravitreal agents, bevacizumab (IVB) 1.25 mg, ranibizumab (RBZ) 0.5, 1.0 and 2 mg, triamcinolone acetonide (IVTA) 1 mg, and aflibercept (IAI) 2 mg. The therapeutic benefit from IVB and RBZ was short-lived - although a decrease in ME and improvement in visual acuity were observed, a completely dry macula was not achieved even after 1 week of treatment with any dose of these agents, including 2.0 mg RBZ. IVTA achieved a dry macula for 7 weeks. IAI yielded a dry macula and improved vision with monthly injections. However, regression of the therapeutic benefit was noted at 5 weeks after the IAI injection. A stronger affinity of IAI to vascular endothelial growth factor (VEGF) compared to other anti-VEGF agents is likely responsible for the observed therapeutic effect for 1 month, making this agent preferable for the management of symptomatic ME in a vitrectomized eye.