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Christopher M Aderman, Ehsan Rahimy, Abtin Shahlaee, Jason Hsu; Conversion to Aflibercept After Prior Anti-VEGF Therapy for Persistent Diabetic Macular Edema: One Year Follow Up. Invest. Ophthalmol. Vis. Sci. 2017;58(8):944.
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Diabetic macular edema (DME) is the leading cause of vision loss in patients with diabetic retinopathy. Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is the standard of care and recent head-to-head analysis of the 3 available anti-VEGF medications (Protocol T) has shown improved outcomes with aflibercept in patients with worse baseline visual acuity. We evaluated functional and anatomic outcomes of patients with persistent DME who were converted from bevacizumab and/or ranibizumab to aflibercept.
This is a retrospective, interventional, noncomparative, consecutive case series. Eyes included in the study were treated with at least 4 consecutive intravitreal injections of ranibizumab/bevacizumab for DME spaced 4-6 weeks apart prior to conversion to aflibercept. These eyes were followed for 12 months post switch and central macular thickness and visual acuity were analyzed. Two-tailed Student’s t-test was used for statistical analysis.
Twenty nine eyes from 26 patients were included in the 12 month follow up analysis. The mean logMAR visual acuity at the pre-switch visit was 0.50 +/- 0.29 (Snellen equivalent, 20/60). This improved to 0.43 +/- 0.32 (Snellen equivalent, 20/50) by the 12 month follow up visit, corresponding to a mean logMAR change of -0.07 +/- 0.21 (P = 0.08). The average central macular thickness from the pre-switch spectral-domain optical coherence tomography scan was 432.5 +/- 133.5 microns, which improved to 327.8 +/- 118.5 microns by the 12 month follow up visit, reflecting a mean decrease of 104.7 +/- 146.7 microns (P < 0.001). The mean intraocular pressure (IOP) recorded at the pre-switch visit was 15.3 +/- 2.5 mm Hg. At the 12 month follow-up after converting to aflibercept, the IOP averaged 13.8 +/- 2.8 mm Hg (P = 0.05).
The average central macular thickness was significantly decreased after switching from bevacizumab and/or ranibizumab to aflibercept at the 12 month follow up visit. While there was a trend toward improved logMAR visual acuity, this was not statistically significant (P = 0.08).
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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