Unusual Treatment Response to Aflibercept, after Ranibizumab Treatment Failure, in Peripheral Exudative Haemorrhagic Retinopathy

Background: To report a case of a peripheral exudative haemorrhagic retinopathy (PEHR) associated with treatment response to Aflibercept (Eylea®) and not Ranibizumab (Lucentis®). Methods: The authors report 79-year-old women with PEHR who had persistent treatment resistance to Ranibizumab, with rapid improvements once switched to Aflibercept. Baseline visual acuity, subjective vision and measurements of anatomical disease were taken using macular optical coherence tomography, wide-field colour, fluorescein and indocyanine-green angiography images. Post-intravitreal injection response was measured using visual acuity, subjective vision and anatomical macular optical coherence tomography findings. Results: Improvements in visual acuity, subjective vision and anatomical resolution of intra-retinal fluid, cysts and retinal thickness were observed by the first Aflibercept injection. Disease remission was maintained with treat-andextend regimen over a 27-month treatment period. Conclusion: This case report highlights the utility of Aflibercept and a treat-and-extend regimen in the management of PEHR, refractive to Ranibizumab. Further larger studies are required to provide evidence to the efficacy and treatment regimens of anti-VEGFs, including Aflibercept, in PEHR.