Aflibercept in diabetic macular edema refractory to previous bevacizumab treatment: Outcomes and possible predictors of success

Session Details

Session Title: Free Paper Session 23: Vascular Diseases & Diabetic Retinopathy VI

Session Date/Time: Sunday 10/09/2017 | 08:00-09:30

Paper Time: 08:24

Venue: Room 120

First Author: : R.Laiginhas PORTUGAL

Co Author(s): :    M. Silva   M. Falcao   V. Rosas   V. Fernandes   A. Carneiro   F. Falcao Reis              

Abstract Details

Purpose:

To evaluate short-term functional and anatomical outcomes after intravitreal aflibercept injections in patients with diabetic macular edema following bevacizumab treatment failure and to identify baseline factors that can predict a favorable response.

Setting:

Patients from the Department of Ophthalmology of Hospital São João.

Methods:

We retrospectively reviewed medical records of patients with diabetic macular edema recalcitrant to bevacizumab who were switched to aflibercept between January and December 2015. All patients had a minimal follow-up of 3 months before the conversion and underwent at least 3 injections of bevacizumab prior to the exchange. Functional outcome consisted in best corrected visual acuity (VA). Anatomical outcomes were demonstrated through central macular thickness (CMT) measured by optical coherence tomography. Pertinent patient data were extracted from clinical charts and tabulated for analysis.

Results:

Forty nine eyes of thirty four subjects met the inclusion and exclusion criteria. Eyes received a median of 6.0 (interquartile range=6.0) bevacizumab injections prior to conversion followed by 5.0 (interquartile range=4.0) aflibercept injections. The mean VA improved from 0.55±0.32logMAR to 0.46±0.33logMAR, p=0.038. The mean CMT decreased from 473±146μm to 349±85μm, p<0.001. Twelve eyes (24%) demonstrated absence of macular edema after aflibercept injections (CMT<300μm). Time of exposure and number of previous bevacizumab injections did not correlate with different outcomes after aflibercept treatment. The variation of VA in response to aflibercept was significantly superior in the group with poorer VA before the switch (mean variation of -0.097±0.21logMAR) when compared to eyes with VA<0.4logMAR (mean variation of +0.019±0.090logMAR), p=0.036. The same scenario was verified for anatomical outcomes as eyes with poor vision before the switch (≥0.4logMAR) achieved superior reduction in CMT in response to aflibercept (mean CMT variation of -157±171μm versus -49.5±39.9μm; p<0.001). Pre-switch CMT was a predictor of CMT reduction after switching to aflibercept therapy (B=-0.945; confidence interval 95%-1.1; -0.76; p<0.001).

Conclusions:

Conversion to aflibercept for persistent diabetic macular edema resulted in significant functional and anatomical improvements and these outcomes were not influenced by characteristics of previous bevacizumab exposition. Pre-switch CMT was a strong predictor of macular changes after switch to aflibercept, so that eyes with greater CMT achieved greater gains.

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