Switch to aflibercept after prior anti-VEGF Therapy in eyes with persistent diabetic macular edema

Session Details

Session Title: Free Paper Session 16: Vascular Diseases & Diabetic Retinopathy IV

Session Date/Time: Friday 08/09/2017 | 16:30-18:00

Paper Time: 17:06

Venue: Room 114

First Author: : J.Mendes Pereira PORTUGAL

Co Author(s): :    A. Campos   P. Alfaiate   M. Santos   H. Aragao   J. Castro Sousa                 

Abstract Details

Purpose:

To evaluate the functional and anatomic outcomes in eyes with persistent diabetic macular edema (DME) who were switched from ranibizumab to aflibercept.

Setting:

Ophthalmology Department, Santo André Hospital, Leiria Hospital centre, Portugal

Methods:

Retrospective, interventional, consecutive case series. Eyes of diabetic patients with DME that were treated with at least a loading dose of ranibizumab and with at least a loading dose of aflibercept thereafter were included. Pertinent patient demographic, examination, and treatment data were extracted from clinical charts and tabulated for analysis.

Results:

30 eyes of 23 patients were included. Eyes received a mean of 6.97 ranibizumab injections prior to conversion, followed by a mean of 4.38 aflibercept injections. The mean±SD best corrected visual acuity (BCVA) at the pre-switch visit was 63.1± 12.8 ETDRS letters. Following the switch, the BCVA improved to 65.7±16.9 letters by the visit after the loading dose of aflibercept (p<0,05). The mean±SD central macular thickness (CMT) at the pre-switch visit was 445.5±144.4 µm. The CMT significantly improved to 381.3±113.4 µm after the loading dose of aflibercept (p<0.05). A total of 16 eyes were followed for 6 months after switching. At month 6 of pro re nata aflibercept CMT further decreased from 470.7±146.1 µm to 400.4±149.5 µm and BCVA improved from 59.6±12.5 to 62±16.8 letters (p>0.05). Mean central choroid thickness was 319.5±77.6 µm prior to switch and 325.9±80.9 µm after of the loading dose of aflibercept (p>0.05). The glycated haemoglobin was 7.2±1.2 % pre-switch and 7.1±1.2 % after switching (p>0.05).

Conclusions:

Switching to aflibercept for persistent DME seemed to result in a significant CMT reduction and significant improvement in visual acuity after the loading dose. The improvement in the CMT and BCVA were not maintained at 6 months. Central choroid thickness and glycosylated haemoglobin were not significantly different before and after the switch to aflibercept. Our sample is small and enrolled both eyes. Further follow up with enrollment of more eyes will probably yield more statistically significant data. Recent treatment strategies in persistent DME tend to switch only after 5 injections of ranibizumab and eyes with baseline BCVA less that 65 letters will probably get better results in the first year if they start with aflibercept.

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