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Peter Karth, Darius M Moshfeghi, Theodore Leng; Aflibercept therapy for diabetic macular edema resistant to ranibizumab and bevacizumab. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1775.
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To evaluate the anatomic and visual acuity outcomes of intravitreal aflibercept 2.0 mg in cases of diabetic macular edema (DME) with persistent fluid on spectral domain optical coherence tomography (SD-OCT) despite regular intravitreal injections (IVI) of ranibizumab 0.5 mg and/or bevacizumab 1.25 mg.
In this retrospective interventional case series, DME patients with persistent retinal fluid despite regular IVI therapy with ranibizumab 0.5 mg and/or bevacizumab 1.25 mg were switched to IVI aflibercept 2.0 mg. Collected data includes details of prior treatments, best available visual acuity, central subfield thickness (CST), and the area of thickest edema on registered SD-OCT before and after aflibercept IVI.
A total of 13 eyes with persistent DME were included. All eyes had persistent fluid after at least 3 monthly ranibizumab or bevacizumab IVIs (range 3-12). At 1 month after the first aflibercept IVI, 77% (10/13 eyes) showed anatomic improvement although none were fluid free; 23% (3/10 eyes) showed stable or worsening edema. On average, CST decreased from 411 to 332 microns (19%; p<0.023) after one aflibercept IVI. When measuring the thickest point in the macula on registered SD-OCT, the thickness decreased from 536 to 466 microns (13%; p<0.030) after one aflibercept IVI. All eyes followed over multiple aflibercept injections showed further improvement (3 eyes). Visual acuity improved in 3 of 10 eyes one month after the first aflibercept IVI (p=0.61). Treatment was well tolerated with no adverse events.
A majority of DME cases with persistent fluid on SD-OCT despite regular ranibizumab 0.5 mg and/or bevacizumab 1.25 mg IVIs showed a positive anatomic response to aflibercept 2.0 mg. IVI aflibercept appears to be anatomically beneficial in cases of DME with persistent fluid despite treatment with ranibizumab and/or bevacizumab.
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