Long term anatomical and functional results with the switch from bevacizumab to aflibercept, in eyes with diabetic macular edema

Session Details

Session Title: Free Paper Session 2: Vascular Diseases & Diabetic Retinopathy I

Session Date/Time: Thursday 07/09/2017 | 09:00-10:30

Paper Time: 10:06

Venue: Room 117

First Author: : M.Silva PORTUGAL

Co Author(s): :    R. Laiginhas   M. Falcao   V. Rosas   S. Penas   A. Carneiro   F. Falcao Reis              

Abstract Details

Purpose:

Diabetic macular edema, a manifestation of diabetic retinopathy, is the main cause of visual acuity loss in patients with Diabetes Mellitus. The role of the vascular endothelial growth factor (VEGF) is widely known and therapeutics directed to its inhibition, by intravitreal injection, has proven efficacy and safety. The purpose of this study is to analyze anatomical and functional results, at 6 and 12 months, of eyes with DME, whose treatment was switched from intravitreal bevacizumab to aflibercept.

Setting:

Ophthalmology department of Sao Joao Hospital, Oporto - Portugal.

Methods:

This is a retrospective study of eyes with DME, that do not respond or whose response to therapy was lost to subsequent intravitreal injections of bevacizumab, whose therapy has been modified to aflibercept. The electronic records of patients submitted to the switch were reviewed and were selected patients that had a minimum follow-up of 3 months before switching, a minimum follow-up of 6 month after the switch and that were subjected to at least 3 bevacizumab injections prior to the switch. The changes in logMAR best corrected visual acuity (VA) and in central macular thickness (CMT), evaluated by optical coherence tomography, were analyzed.

Results:

42 eyes of 29 patients were considered. The mean age of the patients was 66.2 ± 7.1, and 55.2% were men. Before the switch, the mean follow-up was 31.9 ± 17.9 months and the patients were submitted to a mean of 7.4 ± 4.5 bevacizumab injections. 90.5% of the eyes had diabetic retinopathy treated with panretinal and macular grid photocoagulation at the time of the switch. The mean logMAR VA before the switch was 0.59 ± 0.32 and the CMT was 469.9 ± 106.1µm. After the switch, the patients made a mean of 6.1 ± 2.7 aflibercept injections and the mean follow-up was 11.5 ± 3.3 months. At 6 months after the switch, the mean logMAR VA was 0.55 ± 0.40 and the CMT was 362.2 ± 107.6µm. The difference was statistical significant for the mean CMT (p < 0.001) but not for the mean visual acuity (p = 0.399). 21 eyes were evaluated at 12 months. In these, the mean logMAR VA after the switch was 0.48 ± 0.38 and the CMT was 358.4 ± 100.7µm. The difference was statistical significant for the mean CMT (p < 0.001) but not for the mean VA (p = 0.098).

Conclusions:

In eyes with persistent and resistant to therapy with bevacizumab DME, conversion to aflibercept seems to contribute to a significant anatomical improvement at 6 months, which is even greater after 1 year. Although we observed a trend for improvement of visual acuity with the exchange of drug, especially at 12 months, this difference was not statistically significant, perhaps due to the small sample size.

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