RT Journal Article
A1 Chang, Andrew Alexander
A1 Hong, Thomas Hai Le
A1 Broadhead, Geoffrey
A1 Wong, Lily
A1 Joachim, Nichole
A1 Syed, Adil
A1 Zhu, Meidong
T1 Intravitreal Aflibercept for Treatment-Resistant Diabetic Macular Edema: 3-month findings
JF Investigative Ophthalmology & Visual Science
JO Invest. Ophthalmol. Vis. Sci.
YR 2015
VO 56
IS 7 
SP 1761
OP 1761
SN 1552-5783
AB  To assess the efficacy of switching to intravitreal aflibercept in patients with diabetic macular edema (DME) resistant to treatment with other anti-vascular endothelial growth factor (anti-VEGF) agents. Twenty one participants with treatment-resistant DME were enrolled in a prospective, open-label trial of 5 loading injections of aflibercept 4 weeks apart followed by injections every 8 weeks. Inclusion and exclusion criteria included: persistent DME despite at least 4 anti-VEGF injections within 6 months, central macular thickness (CMT) ≥300µm and haemoglobin A1C (HbA1C) ≤12% at baseline. Participants underwent full ophthalmic examinations at each visit including; best-corrected visual acuity (BCVA) in early treatment in diabetic retinopathy study (ETDRS) letters and spectral-domain optical coherence tomography (SD-OCT) to measure CMT. Changes in mean BCVA and CMT were compared between baseline and week 12 using paired t tests. Pearson’s correlation was used to assess the correlation between a change in BCVA and a change in CMT. At baseline, mean HbA1C was 7.4 ± 1.1%. Mean baseline BCVA and CMT was 69.0 ± 10.3 letters and 408.7 ± 111.5 µm respectively. After 3 loading injections, mean BCVA improved by 3.2 ± 7.2 letters (p=0.06) compared to baseline, with 42.9% of participants improving by ≥5 letters by week 12. Compared to baseline, mean CMT improved by 35.5 ± 69.3 µm (p=0.03) at week 12, with 38.1% of participants improving by ≥50 µm by week 12. A change in BCVA was not correlated with a change in CMT after 12 weeks (r²=-0.31, p>0.05). Intravitreal aflibercept shows early effectiveness in improving vision and reducing CMT in previously treatment-resistant DME over 12 weeks. Longer follow-up is required to determine the response of a complete loading dose and the sustainability of improvements. 
RD 1/25/2021