Intravitreal Aflibercept for the Treatment of Subacute Central Serous Chorioretinopathy: A Prospective, Randomized Study

Purpose: To evaluate the role of intravitreal aflibercept (IVA) for treating persistent central serous chorioretinopathy (CSCR) of more than 6 weeks. Methods: AFlibercept Efficacy in Cscr Treatment (NCT01971190) was a 6-month, phase 2, multicenter, prospective, randomized, controlled clinical trial at 6 clinical sites in Korea. Forty-three patients were randomized into group 1 (29) with 3 monthly IVA administrations or group 2 (14) with sham treatment and followed for 6 months with pro re nata (PRN) IVA. Patients could be retreated with IVA when they met the eligibility criteria for this. The primary end point was a mean change in central subfield thickness (CST) from baseline. Best-corrected visual acuity (BCVA) and CST were checked monthly. Data from a subgroup with long-term follow-up in a real-life practice were also compared. Results: After 3 months of treatment, group 1 had a greater change in mean CST (173.97 vs 80.15 µm; P =.001) and BCVA improvement (10.38 vs 8.62 Early Treatment of Diabetic Retinopathy Study letters; P =.52) than group 2. Among patients whose disease had lasted ≥3 months, BCVA improvement was significantly better in group 1 than in group 2 after 3 months (12.0 vs −2.7 letters; P =.007), and the percentage of eyes requiring PRN IVA was lower in group 1 (50% vs 100%). These differences were attenuated at 6 months but maintained during additional 6-month follow-up. Conclusion: Intravitreal aflibercept may facilitate the anatomical improvement in persistent CSCR and may improve the visual outcomes in relatively chronic cases. The IVA injection may be a therapeutic option for CSCR.