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Yonwook Justin Kim, Tara Bryant, Archana Seethala Thangappan, Manju Subramanian; Accelerated Anti-VEGF Dosing for Treatment Resistant Macular Edema in Patients with Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5026.
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Diabetic macular edema (DME) is the thickening of the retina due to disruption in the blood-retina barrier that leads to an increase in vascular permeability. While anti-VEGF injections have been demonstrated to be an effective treatment for DME, there remains a population of patients who show little improvement despite consecutive monthly injections. Although such population may benefit from more frequent injections, there is no study in the literature that explores the outcome of increasing the injection frequency. The objective of this study is to examine the clinical outcomes of accelerated anti-VEGF injections for patients with DME who have previously failed the monthly treatments.
We performed a retrospective chart review of patients who received bimonthly anti-VEGF injections for DME at the Boston Medical Center between January 1, 2015 and September 15, 2016. The subjects were screened using the CPT code for intravitreal injection and dates of injections. Age, sex, ocular comorbidities, indication for injection, site of injection, injected medication, and dates of injection were recorded for each patient. Outcome measures included central foveal thickness and best corrected visual acuity at the start of bimonthly treatments and at the end of accelerated treatments.
Total of 10 eyes in 8 patients were identified to have received bimonthly intravitreal anti-VEGF injections for DME with an average age of 64.7 (range: 53 - 75). All patients had failed the traditional monthly injection therapy previously. All patients received and average of 10.9 (range: 2 - 21) injections that were alternated between bevacizumab and aflibercept. The average central foveal thickness was 480.1 microns (range: 305 - 713) before treatment and 421.7 microns (range 237 - 732) after treatment. Six eyes had a decrease in central foveal thickness by at least 20 microns while four showed no improvement. Four eyes showed improvement in best corrected visual acuity while six worsened or had no improvement. There was no reported complication.
Accelerated anti-VEGF treatment regiment may improve visual acuity and reduce central foveal thickness in some patients with DME that failed monthly therapy. Further investigation is needed to fully explore the efficacy, risks, and benefits of increasing the frequency of anti-VEGF injections in patients who do not respond to monthly therapy.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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