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A Randomized Clinical Trial

Casselholm de Salles, Manuel MD; Amrén, Urban MD, PhD; Kvanta, Anders MD, PhD; Epstein, David L. MD, PhD

doi: 10.1097/IAE.0000000000002171
Original Study

Purpose: To prospectively investigate the injection frequency of aflibercept and ranibizumab in the treatment of macular edema in central retinal vein occlusion.

Methods: Patients with treatment-naive central retinal vein occlusion and macular edema were randomized to receive intravitreal injections with aflibercept (n = 22) or ranibizumab (n = 23) in a treat-and-extend regimen with a follow-up time of 18 months. After 3 loading doses, the treatment intervals were extended by 2 weeks to a maximum of 12 weeks. Intervals were shortened by 2 weeks if macular edema recurred.

Results: The number of injections was significantly lower in the aflibercept group with a mean of 10.9 injections (95% confidence interval, 9.6–12.3) compared with 14.4 in the ranibizumab group (95% confidence interval 12.7–16.1) at study completion (P = 0.0017). The mean treatment interval was significantly longer in the aflibercept group compared with the ranibizumab group 10.0 (95% confidence interval, 8.7–11.3) and 6.6 (95% confidence interval, 5.2–8.0) weeks, respectively (P < 0.001). No significant difference between the groups regarding visual acuity or central retinal thickness was observed.

Conclusion: Patients with macular edema secondary to central retinal vein occlusion required significantly fewer intravitreal injections of aflibercept compared with ranibizumab when treated with a treat-and-extend regimen. This may reduce the treatment burden and, to some extent, the need for close monitoring of patients.

This is a prospective randomized study of the injection frequency with ranibizumab and aflibercept for macular edema secondary to central retinal vein occlusion. Patients in the aflibercept group received significantly fewer injections compared with those in the ranibizumab group.

Karolinska Institutet, St. Erik Eye Hospital, Stockholm, Sweden.

Reprint requests: Manuel Casselholm de Salles, MD, Department of Ophthalmology, Karolinska Institutet, St. Erik Eye Hospital, Polhemsgatan 50, Stockholm 11282, Sweden; e-mail:

None of the authors has any financial/conflicting interests to disclose.

© 2019 by Ophthalmic Communications Society, Inc.