Conversion to Aflibercept for Diabetic Macular Edema Unresponsive To Bevacizumab in Chicago Cook County Health System.

Abstract

Purpose : Chicago’s Cook County Hospital and Health System (CCHHS) is one of the largest public county hospitals in the USA, serving a diabetic patient population with limited access to preventative screening and primary care services, thus representing a unique subset, unrepresentative of the general population. Consequently, these individuals are more likely to have poorly controlled diabetes and present later in the course of their disease with more severe and longstanding diabetic macular edema (DME). The purpose of this study was to investigate if eyes with DME not adequately controlled with bevacizumab would benefit from conversion to aflibercept in our diabetic population.

Methods : This study was a retrospective chart review of eyes with persistent DME after a series of at least three intravitreal injections (IVI) with bevacizumab 1.25 mg every 4-6 weeks that were subsequently converted to IVI of aflibercept 2 mg. Collected data included visual acuity and central foveal thickness (CFT) on registered Heidelberg spectral-domain optical coherence tomography (SD-OCT).

Results : In total, 23 eyes from 17 subjects of mean age of 63.2 years were included. The mean glycosylated hemoglobin (HgbA1c) was 7.61%. Mean CFT immediately prior to the switch was 428 micrometers and mean visual acuity was 0.480 logMAR. To date, mean number of afibercept IVI was 1.9 (range 1-3 injections) and mean follow-up after switching to aflibercept was 2.9 months (range 1-7 months). Anatomical improvement on OCT was shown in 91.3% of eyes (21 out of 23 eyes) after conversion to afibercept IVI. Mean CFT after afibercept IVI decreased significantly to 330 micrometers (P=0.0077). Visual acuity improved in 43.5% of eyes (10 out of 23 eyes) after conversion to afibercept with mean visual acuity of 0.375 logMAR at the end of follow-up (P=0.063).

Conclusions : Eyes with persistent DME unresponsive to bevacizumab IVI demonstrate anatomical and visual acuity improvement after conversion to aflibercept in our diabetic population at CCHHS in Chicago.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.