Abstract
Purpose :
Aflibercept is effective for diabetic macular edema (DME). We compare visual outcomes in centres using a 3 loading doses with centres which use a 5.
Methods :
Anonymised data of patients undergoing antiVEGF injections for DME were exported from an ophthalmology electronic patient record. Those who had aflibercept injections only were included. Centres in which the median time between 3rd and 4th injection and 4th and 5th injection was 35 days or fewer were coded as 5 dose loading protocol centres and the rest as 3 dose loading protocol centres. The first eye treated in each patient was used. Wilcoxon Rank Sum test was used to compare groups. Linear regression was used to relate change in visual acuity (VA) over 12 months from the first injection, age (grouped <65 years, 65 to 74, 75 and above), baseline ETDRS letter score (<50 letters, 50 to 59, 60 to 69, 70 to 79, 80 or more) and number of injections.
Results :
Of 21 centres in the audit 16 had 10 or more patients to enable decision to be made about protocol group. There were 10 centres with a 3 loading dose protocol and 6 centres with a 5 loading dose protocol. The 1130 patients included were of median age 64 (57 to 73) years (median (25th to 75th centile), with the baseline VA of 64 (54 to 72) ETDRS letters and had received 6 (5 to 8) injections. Over 12 months the change in letter score was 5 (0 to 12).
There were 763 patients in the 3 dose group and 367 patients in the 5 dose group. Those in the 3 dose group had 4.2 (1.2) (mean (s.d.) injections in 12 months and those in 5 dose group 4.8 (1.2) (p<0.0001). At 12 months the improvement in VA was 5 (-1 to 12) in the 3 dose group and 5 (0 to 12) in the 5 dose group (p= 0.79). Those in the 3 dose group had 5.8 (2.0) (mean (s.d.)) injections in 12 months and those in 5 dose group 6.6 (1.9) (p<0.0001). At 12 months the improvement in VA was 5 (-1 to 12) in the 3 dose group and 5 (0 to 12) in the 5 dose group (p= 0.79).
In regression analysis change in VA over 12 months was associated with age (p=0.0003), baseline ETDRS letter score (p<0.0001). Number of injections (p=0.07) and protocol (p=0.60) were not significantly associated with change in VA.
Conclusions :
At 6 months and at 12 months there was no difference in visual outcome between those in centres using a 3 loading dose protocol and those using a 5 loading dose protocol.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.