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Conversion to Aflibercept After Prior Anti-VEGF Therapy for Persistent Diabetic Macular Edema

Published:December 31, 2015DOI:https://doi.org/10.1016/j.ajo.2015.12.030

      Purpose

      To evaluate the short-term functional and anatomic outcomes of patients with persistent diabetic macular edema (DME) who were converted from bevacizumab and/or ranibizumab to aflibercept.

      Design

      Retrospective, interventional, noncomparative, consecutive case series.

      Methods

      Only eyes treated with at least 4 consecutive injections of ranibizumab/bevacizumab spaced 4–6 weeks apart prior to conversion and with at least 2 aflibercept injections afterward were considered for inclusion. Pertinent patient demographic, examination, and treatment data were extracted from clinical charts and tabulated for analysis.

      Results

      Fifty eyes of 37 patients were included. Eyes received a mean of 13.7 bevacizumab/ranibizumab injections prior to conversion, followed by 4.1 aflibercept injections over 4.6 months of subsequent follow-up. The mean logMAR visual acuity at the pre-switch visit was 0.60 ± 0.43 (Snellen equivalent, 20/80). This improved to 0.55 ± 0.48 (Snellen equivalent, 20/70) by the second visit after conversion, corresponding to a mean logMAR change of −0.05 ± 0.22 (P = .12). The average central macular thickness from the pre-switch spectral-domain optical coherence tomography scan was 459.2 ± 139.2 μm. This significantly improved to 348.7 ± 107.8 μm by the second visit following conversion, reflecting a mean decrease of 112 ± 141 μm (P < .0001). The mean intraocular pressure (IOP) recorded at the pre-switch visit was 15.1 ± 3.3 mm Hg. At the second follow-up after converting to aflibercept, the IOP averaged 14.9 ± 3.2 mm Hg, with a mean decrease of 0.2 ± 3.0 mm Hg (P = .63).

      Conclusions

      Conversion to aflibercept for persistent DME resulted in significant anatomic improvements. While trends towards improved visual acuity and reduction in IOP were observed, these were not statistically significant.
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      Biography

      Ehsan Rahimy is currently a vitreoretinal specialist at the Palo Alto Medical Foundation. He recently completed his vitreoretinal fellowship at Wills Eye Hospital. Prior to that he received his undergraduate degree in Cellular & Molecular Biology from the University of Michigan, followed by medical school at Baylor College of Medicine, and then residency at the Jules Stein Eye Institute, UCLA. He was acknowledged as a 2014–15 Heed Ophthalmic Foundation Fellow and a Ronald G. Michels Fellow.

      Biography

      Abtin Shahlaee is a post-doctoral research fellow at Wills Eye Hospital in Philadelphia, PA. He received his medical degree from Tehran University of Medical Sciences and was was a former research assistant at the Department of Ophthalmology at the Medical University of Vienna. His current research projects focus on diseases of the retina and applications of novel imaging techniques.

      Linked Article

      • Conversion to Aflibercept After Prior Anti-VEGF Therapy for Persistent Diabetic Macular Edema
        American Journal of OphthalmologyVol. 168
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          The study by Rahimy and associates1 assessed the short-term visual and anatomic outcomes of patients with persistent diabetic macular edema (DME) who were converted from bevacizumab (Avastin; Genentech, Inc, South San Francisco, California, USA) and/or ranibizumab (Lucentis; Genentech, Inc) to aflibercept (Eylea; Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA). The article has several shortcomings that prevent the validation and extrapolation of their results and that can be specifically summarized as follows.
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