Conversion to aflibercept for diabetic macular edema unresponsive to ranibizumab or bevacizumab

Abstract

Background: The purpose of this study was to determine if eyes with diabetic macular edema (DME) unresponsive to ranibizumab or bevacizumab would benefit from conversion to aflibercept.

Methods: This study was conducted as a retrospective chart review of subjects with DME unresponsive to ranibizumab and/or bevacizumab and subsequently converted to aflibercept.

Results: In total, 21 eyes from 19 subjects of mean age 62±15 years were included. The majority of subjects were male (63%). The median number of ranibizumab or bevacizumab injections before switching to aflibercept was six, and the median number of aflibercept injections after switching was three. Median follow-up was 5 months after the switch. Mean central foveal thickness (CFT) was 453.52±143.39 mm immediately prior to the switch. Morphologically, intraretinal cysts were present in all cases. Mean CFT after the first injection decreased significantly to 362.57±92.82 mm (Wilcoxon signed-rank test; P<0.001). At the end of follow-up, the mean CFT was 324.17±98.76 mm (P<0.001). Mean visual acuity was 0.42±0.23 logMAR just prior to the switch, 0.39±0.31 logMAR after one aflibercept injection, and 0.37±0.22 log-MAR at the end of follow-up. The final visual acuity was significantly better than visual acuity before the switch (P=0.04).

Conclusion: Eyes with DME unresponsive to multiple ranibizumab/bevacizumab injections demonstrate anatomical and visual improvement on conversion to aflibercept.

Keywords: aflibercept; bevacizumab; diabetic retinopathy; macular edema; ranibizumab.

Figure 1

Change in mean central foveal thickness (µm).

Figure 2

Change in mean logMAR visual acuity.

Figure 3

This 78-year-old woman had long-standing diabetes with a recent HbA_1c of 7.5%. Notes: (A) After four bevacizumab injections, the right eye had persistent center-involving diabetic macular edema with a CFT of 516 mm and large cystoid spaces. (B) The CFT decreased to 455 mm after one aflibercept injection. (C) After six aflibercept injections, the CFT was 357 mm and the cystoid spaces had resolved, although a hyperreflective clump of hard exudates was still seen with ellipsoid zone disruption. Abbreviations: CFT, central foveal thickness; HbA_1c, glycated hemoglobin.