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Ehsan Rahimy, Abtin Shahlaee, M. Ali Khan, Gui-Shuang Ying, Joseph Maguire, Allen Ho, Carl D Regillo, Jason Hsu; Conversion to aflibercept after prior anti-VEGF therapy for persistent diabetic macular edema. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2071.
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© ARVO (1962-2015); The Authors (2016-present)
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.
Only eyes treated with at least 4 consecutive injections of bevacizumab/ranibizumab spaced 4-6 weeks apart prior to conversion and with at least 2 aflibercept injections afterwards were considered for inclusion. Pertinent patient demographic, examination, and treatment data were extracted from clinical charts and tabulated for anlaysis.
Fifty eyes of 37 patients were included. Eyes received a mean of 13.7 bevacizumab/ranibizuman injections prior to conversion, followed by 4.1 aflibercept injections over 4.6 months or 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=0.12). The average central macular thickness from the pre-switch spectral-domain optical coherence tomography scan was 459 +/- 139 microns. This significantly improved to 349 +/- 108 microns by the second visit following conversion, reflecting a mean decrease of 112 +/- 141 microns (P<0.0001). The mean intraocular pressure (IOP) recorded at the pre-switch visit was 15.1 +/- 3.3 mmHg. At the second follow-up after converting to aflibercept, the IOP averaged 14.9 +/- 3.2 mmHg, with a mean decrease of 0.2 +/- 3.0 mmHg (P=0.63).
Conversion to aflibercept for persistent DME resulted in significant anatomical improvements. While trends towards improved visual acuity and reduction in IOP were additionally observed, these were not statistically significant.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Comparison of visual acuity, central macular thickness, and intraocular pressure before and after conversion to aflibercept for diabetic macular edema through first 2 post-switch visits (n=50 eyes). Dashed line indicates where switch to aflibercept occurred.
Anatomical improvement after conversion to aflibercept for diabetic macular edema (DME). Four representative cases of persistent DME previously receiving chronic anti-VEGF therapy with corresponding spectral-domain optical coherence tomography images at the pre-switch visit (left column), first visit following conversion (middle column), and the second visit following conversion (right column).
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