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Marko Lukic, Zaid Shalchi, Gwyn Williams, Praveen Patel, Robin Hamilton, Ranjan Rajendram; Twelve Months Outcomes in Switched Patients Treated with Intravitreal Aflibercept for Diabetic Macular Oedema. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3600.
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In everyday clinical practice, it has been observed that despite the outcomes of the large trials, a significant number of patients do not respond completely to multiple injections of a given intravitreal anti-VEGF agent. This is a retrospective, real-life, cohort study in which we investigated the functional and anatomical outcomes of patients switched from ranibizumab to aflibercept for treatment of diabetic macular oedema (DMO) over 12 months.
Ninety eyes (67 patients) with DMO were included. All patients were followed up for 12 months after the first injection of aflibercept was given. Parameters measure included visual acuity(VA), optical coherence tomography(OCT)- derived central foveal thickness(CFT), and macular volume(MV) at baseline and month 12.Secondary outcomes were ≥ 15ETDRS letters gain and ≥ 100 microns decrease in CFT in the end of follow up. The tertiary outcomes were subgroup analysis according to time of switching. The paired t-test was used for statistical analysis.
Our cohort had mean 6.58 injections of aflibercept over the 12-month period. The mean VA(SD) at baseline was 63.01(15.78) ETDRS letters. The mean baseline CFT(SD) was 418(158) µm and the mean baseline MV(SD) was 9.96(2.44) mm3. After 12 months, the mean VA(SD) increased to 67.19(15.80) ETDRS letters (p = .0048). All anatomical outcomes, the mean CFT(SD) and mean MV(SD), improved at 12 months and were 281(110) μm (p < .0001) and MV 8.43(1.81) mm3 (p < .0001), respectively. Additionally, 13(14.44%) eyes gained ≥ 15ETDRS letters at month 12. Forty-five (51.72 %) eyes had a decrease in CFT of ≥ 100 microns.We sub-divided the switched eyes into two subgroups according to the duration of time between the ranibizumab being discontinued and the aflibercept commencing; 53 eyes were switched less than 3 months after the last injection of ranibizumab and 37 eyes were switched after between 3 months and 1 year. The mean (SD)VA, CFT and MV for eyes switched before 3 months had elapsed was 65.66(15.66) ETDRS letters, 273(122) µm, 8.63(2.08) mm3 at the end of follow up period whilst in the other subgroup the mean (SD) VA, CFT, MV were 69.38(15.96) ETDRS letters, 29 (91) µm and 8.14(1.31) mm3, respectively.
Our cohort showed improvement in both visual and anatomical parameters after switching over 12-month period. Time of switching did not show as significant factor in outcome results.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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