Efficacy of Aflibercept Treatment and Its Effect on the Retinal Perfusion in the Oxygen-Induced Retinopathy Mouse Model of Retinopathy of Prematurity

<b><i>Introduction:</i></b> Bevacizumab and ranibizumab, which are anti-vascular endothelial growth factor (VEGF) medications, are used frequently in the treatment for retinopathy of prematurity (ROP) in infants. Aflibercept, or VEGF Trap, has been used anecdotally, but translation and clinical studies are lacking. <b><i>Objective:</i></b> This study investigates the efficacy of aflibercept at reducing areas of non-perfused retina and studies its effect on normal angiogenesis in the oxygen-induced retinopathy mouse model of ROP. <b><i>Methods:</i></b> C57BL/6 J mice were assigned to room air control (<i>n</i> = 21 eyes) or hyperoxia with 75% oxygen (<i>n</i> = 84 eyes). The hyperoxic mice were assigned to 1 of 3 groups: 0 ng (<i>n</i> = 14 eyes), 100 ng (<i>n</i> = 35 eyes), or 1,000 ng (<i>n</i> = 35 eyes) of intravitreal aflibercept administered on postnatal day 14. Eyes were enucleated at PN17 and PN25 postinjection. Retinas were stained with anti-collagen IV antibody and photographed with microscopy. Areas of perfused and non-perfused retina were quantified using ImageJ software. Statistical comparisons were made using ANOVA with Tukey post hoc comparisons. <b><i>Results:</i></b> At PN17, there was no significant difference in the area of non-perfused retina between the hyperoxic control and the 100 and 1,000 ng aflibercept groups. At PN25, the 100 ng (<i>p</i> &#x3c; 0.05) and 1,000 ng (<i>p</i> = 0.008) treatment groups displayed less non-perfusion compared to hyperoxic controls. At the 1,000 ng dose, there was increased non-perfusion compared to the 100 ng dose (<i>p</i> = 0.02). There was reduced non-perfusion by PN25 compared to PN17 for the 100 ng group (<i>p</i> &#x3c; 0.05), with no difference in the 1,000 ng group. <b><i>Conclusions:</i></b> The study shows that the area of non-perfused retina decreases effectively with aflibercept at PN25 with 100 ng dosage. With the 1,000 ng dosage, there is an inhibition of the physiologic angiogenesis with a higher area of non-perfused retina.