Intravitreal Aflibercept Injection for Symptomatic Macular Edema From Retinal Artery Macroaneurysms

Baseline evaluation will consist of measurement of best-corrected ETDRS visual acuity,
complete eye exam, including IOP measurement, color photos and intravenous fluorescein
angiography, spectral domain OCT and vitals. Patients meeting eligibility criteria will be
treated with an intravitreal injection of 2.0 mg aflibercept under usual aseptic
precautions. Follow up visits will be on Day 7, 30, 60, 90, 120, 150 and 180. At each
follow-up visit, best-corrected ETDRS visual acuity, IOP measurement and central foveal
thickness (CFT) by SDOCT will be obtained. Color photos and IVFA will be performed at month
3 and 6 visits.

Retreatment shall be performed no sooner than two months after previous injection for one or
more the following criteria 1. CFT >310 microns 2. Intraretinal or subretinal fluid on SDOCT
3. Increase in CFT by 50 or more microns from the lowest value observed after intravitreal
aflibercept injection 4. Decrease in vision by 5 or more letters frpm the previous visit
associated with OCT evidence of macular edema. 5. Appearance of new hemorrhage on color
photographs.

Final follow-up will be at six months. Data collected will include, change in ETDRS visual
acuity from the baseline, change in CFT, number of injections, number of eyes completely dry
by SDOCT, and number of eyes with a thrombosed RAM by IVFA.

Inclusion Criteria:

1. Symptomatic macular edema caused by RAM in one of the eyes. If both eyes are
involved, the eye with worse central foveal thickness will be enrolled in the study.

2. CFT of 310 microns or more by spectral domain OCT or lipid in the center of the fovea

3. Best-corrected visual acuity of 73 to 24 letters.

4. Willing and able to comply with clinic visits and study-related procedures.

5. Willing to provide informed consent -

Exclusion Criteria:

1. Media opacity

2. pre-retinal fibrosis, retinal detachment, vitreo-macular traction

3. Infectious keratitis, conjunctivitis, blepharitis or scleritis

4. Any ocular surgery during the preceding 3 months.

5. aphakia or uncontrolled glaucoma

6. subfoveal hemorrhage

7. History of systemic or intravitreal anti-VEGF injections, intravitreal steroid
injection or implant, or laser treatment to RAM within six months

8. Any other ocular disease responsible for decrease in vision.

9. Concomitant ocular disease that can cause increase in foveal thickness

10. Ocular inflammation from any cause

11. Recent (<3 months) history of a thromboembolic event

12. Pregnant or breast feeding women.

13. Sexually active men or women of child bearing potential who are unwilling to practice
adequate contraception during the study.