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Adam R Glassman; Association of Early Response to Anti-VEGF Injections for Diabetic Macular Edema with Visual Outcomes Two Years Later: Post-hoc Analysis of DRCR.net Protocol T. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4824.
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Assess association of visual acuity outcomes at 2 years with visual acuity and optical coherence tomography (OCT) central subfield thickness (CST) at 12 weeks following anti-VEGF treatment for diabetic macular edema (DME).
Post-hoc analyses of DRCR.net Protocol T. Eyes received monthly anti-VEGF injections (unless success after 3 to 5) after randomization to 2.0-mg aflibercept, 1.25-mg bevacizumab, or 0.3-mg ranibizumab; subsequent injections or focal/grid laser or both were given as needed per protocol.
Visual acuity response at 12 weeks was associated with change in visual acuity from baseline at 2 years in each treatment group (multivariable P<.001). However, there was substantial individual variability, which precluded confident prediction of subsequent outcomes based on the 12-week response. For example, among eyes with <5-letter gain from baseline at 12 weeks, 20/48 (42%), 21/68 (31%), and 28/59 (47%) eyes in the aflibercept, bevacizumab, and ranibizumab groups, respectively, gained 10 or more letters from baseline at 2 years. Central subfield thickness response at 12 weeks was not as strongly associated with 2-year change in visual acuity. Among eyes with <10% vs. ≥20% CST decrease at 12 weeks, the number of eyes gaining 10 or more letters of vision at 2 years was 18/32 (56%) vs. 74/112 (66%) in the aflibercept group, 28/71 (39%) vs. 45/68 (66%) in the bevacizumab group, and 25/43 (58%) vs. 59/95 (62%) in the ranibizumab group.
Following three consecutive anti-VEGF injections for DME, visual acuity response at 12 weeks was associated with 2-year change in visual acuity, but with substantial individual variability. However, up to half of eyes with <5-letter gain at 12 weeks gained 10 or more letters from baseline at 2 years. Until the risks and benefits of specific alternative therapies have been clearly established, these data suggest that caution should be advised before considering alternative treatments 12 weeks after initiating anti-VEGF therapy for DME.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Mean change in visual acuity (VA) letter score at 2 years for eyes gaining < 5 letters at 12 weeks.
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