First Author: T.Queirós PORTUGAL
Co Author(s): R. Gentil G. Santos L. Mendonca C. Ferreira P. Brito N. Gomes
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To evaluate functional and anatomic outcomes in eyes with persistent DME, unresponsive to bevacizumab and/or ranibizumab who were converted to aflibercept.
Department of Ophthalmology, Hospital de Braga, Portugal
A retrospective study was conducted in patients with persistent diabetic macular edema unresponsive to bevacizumab (1.25 mg) and/or ranibizumab (0.3 mg) who were converted to aflibercept (2.0 mg) therapy, between April 2015 and October 2016, at the Ophthalmology department of Hospital de Braga. Eligible participants were aged 18 years or older with a history of diabetes mellitus (type 1 or type 2) and baseline evidence of clinically significant macular edema with central macular thickness (CMT) ≥ 300 µm. The main outcomes were: best-corrected visual acuity (BCVA) recorded as Snellen visual acuity and then converted into the logarithm of the minimal angle of resolution (LogMAR); and CMT documented with Spectral-domain optical coherence tomography (Heidelberg Engineering, Heidelberg, Germany).
A total of 36 eyes of 29 patients with a mean age of 64.25 years (± 11.49) were analyzed. The mean number of ranibizumab and/or bevacizumab injections before switching was 7, and the mean number of aflibercept injections after switching was 2.5 over 7.5 months of follow-up. The mean LogMAR BCVA was 0.33 ± 0.27 prior to the switch, which improved to 0.12 ± 0.11 at the end of follow-up, but with no statistically significance. There was a significant improvement in mean CMT from 439.69 ± 89.88 µm pre-switch to 331.94 ± 53.91 by the first visit following conversion (p<0.0001). At the end of follow-up, the mean CMT was 304.28 ± 38.96 µm, which reflects a statistically significant improvement (p<0.0001).
This study demonstrates that conversion to aflibercept in eyes with DME unresponsive to multiple ranibizumab/bevacizumab injections resulted in significant anatomic improvements with trends towards improved visual acuity.