Sir,
We appreciate the interest demonstrated by Tetikoglu et al1 in our publication regarding the use of intravitreal aflibercept as primary treatment for choroidal neovascularisation (CNV) in angioid streaks (AS).2
Currently, anti-vascular endothelial growth factor (VEGF) drugs are the treatment of choice for AS-associated CNV and in this setting, aflibercept is regarded with interest as it has a higher affinity for VEGF-A, as well as the ability to bind VEGF-B and placental growth factor.2 Therefore, it is perfectly reasonable to observe patients refractory to bevacizumab1 and ranibizumab3 to be switched to aflibercept therapy, in alignment with what has been observed in other macular diseases, such as neovascular age-related macular degeneration.4
In addition, we agree with Tetikoglu et al1 that the recurrence time of the AS-associated CNV is not just depended on the drug used. Recurrence seems to be a multifactorial event difficult to predict, with some patients needing repeated injections, while others can be activity-free for several years or even develop new CNV lesions.3, 5 Nevertheless, these case reports1, 2, 3 suggest that aflibercept is a valid effective option to be considered.
References
Tetikoglu M, Sagdik HM, Aktas S, Ozcura F . Intravitreal aflibercept for refractory choroidal neovascularization secondary to angioid streaks. Eye 2016; 30: 894–895.
Vaz-Pereira S, Collaço L, De Salvo G, van Zeller P . Intravitreal aflibercept for choroidal neovascularisation in angioid streaks. Eye (Lond) 2015; 29: 1236–1238.
Esen E, Sizmaz S, Demircan N . Intravitreal aflibercept for management of subfoveal choroidal neovascularization secondary to angioid streaks. Indian J Ophthalmol 2015; 63: 616–618.
Lazzeri S, Ripandelli G, Sartini MS, Parravano M, Varano M, Nardi M et al. Aflibercept administration in neovascular age-related macular degeneration refractory to previous anti-vascular endothelial growth factor drugs: a critical review and new possible approaches to move forward. Angiogenesis 2015; 18: 397–432.
Vaz-Pereira S, Collaço L, De Salvo G, van Zeller P . Intravitreal aflibercept for choroidal neovascularisation in angioid streaks. Eye (Lond) 2016; 30: 639.
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Dr SVP has received consultant fees from Bayer and Novartis and has received travel grants from Bayer, Novartis, Alcon, Allergan and Alimera Sciences. Dr LC has received travel grants from Bayer. Dr GDS has received travel grants from Bayer and Heidelberg Engineering. The remaining author declares no conflict of interest.
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Vaz-Pereira, S., Collaço, L., De Salvo, G. et al. Intravitreal aflibercept for choroidal neovascularisation in angioid streaks. Eye 30, 896 (2016). https://doi.org/10.1038/eye.2016.34
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DOI: https://doi.org/10.1038/eye.2016.34
