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Am J Ophthalmol. 2016 Apr;164:118-27.e2. doi: 10.1016/j.ajo.2015.12.030. Epub 2015 Dec 31.

Conversion to Aflibercept After Prior Anti-VEGF Therapy for Persistent Diabetic Macular Edema.

Author information

1
Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania.
2
Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
3
Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania. Electronic address: jhsu@midatlanticretina.com.

Abstract

PURPOSE:

To evaluate the short-term functional and anatomic outcomes of patients with persistent diabetic macular edema (DME) who were converted from bevacizumab and/or ranibizumab to aflibercept.

DESIGN:

Retrospective, interventional, noncomparative, consecutive case series.

METHODS:

Only eyes treated with at least 4 consecutive injections of ranibizumab/bevacizumab spaced 4-6 weeks apart prior to conversion and with at least 2 aflibercept injections afterward were considered for inclusion. Pertinent patient demographic, examination, and treatment data were extracted from clinical charts and tabulated for analysis.

RESULTS:

Fifty eyes of 37 patients were included. Eyes received a mean of 13.7 bevacizumab/ranibizumab injections prior to conversion, followed by 4.1 aflibercept injections over 4.6 months of subsequent follow-up. The mean logMAR visual acuity at the pre-switch visit was 0.60 ± 0.43 (Snellen equivalent, 20/80). This improved to 0.55 ± 0.48 (Snellen equivalent, 20/70) by the second visit after conversion, corresponding to a mean logMAR change of -0.05 ± 0.22 (P = .12). The average central macular thickness from the pre-switch spectral-domain optical coherence tomography scan was 459.2 ± 139.2 μm. This significantly improved to 348.7 ± 107.8 μm by the second visit following conversion, reflecting a mean decrease of 112 ± 141 μm (P < .0001). The mean intraocular pressure (IOP) recorded at the pre-switch visit was 15.1 ± 3.3 mm Hg. At the second follow-up after converting to aflibercept, the IOP averaged 14.9 ± 3.2 mm Hg, with a mean decrease of 0.2 ± 3.0 mm Hg (P = .63).

CONCLUSIONS:

Conversion to aflibercept for persistent DME resulted in significant anatomic improvements. While trends towards improved visual acuity and reduction in IOP were observed, these were not statistically significant.

PMID:
26748058
DOI:
10.1016/j.ajo.2015.12.030
[Indexed for MEDLINE]

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