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| (c) British Journal of Ophthalmology |
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This retrospective study was undertaken to evaluate functional and anatomical outcomes after aflibercept in patients with diabetic macular edema (DME) in patients with poor response to bevacizumab. All patients with DME between January and December of 2015, who were recalcitrant to bevacizumab injections and were switched to aflibercept, were reviewed. All patients had a minimal follow-up of three months before the conversion and underwent at least three injections of bevacizumab. Functional outcome evaluated was best corrected visual acuity (VA). Anatomical outcomes were demonstrated through central macular thickness (CMT) measured by optical coherence tomography.
Forty-nine eyes of 34 subjects were found to be meet the criteria. Mean VA improved from 0.55 ± 0.32 logMAR to 0.46 ± 0.33 logMAR (p = 0.038). Mean CMT decreased from 473 ± 146 μm to 349 ± 85 μm (p < 0.001).
Twelve eyes (24%) demonstrated absence of macular edema after aflibercept. Previous bevacizumab exposure did not correlate with different outcomes. The variation of VA in response to aflibercept was significantly superior in the group with poorer VA before the switch (mean variation of −0.097 ± 0.21 logMAR) when compared to eyes with VA < 0.4 logMAR (mean variation of +0.019 ± 0.090 logMAR; p = 0.036). The same scenario was verified for anatomical outcomes as eyes with poor vision before the switch (≥0.4 logMAR) achieved superior reduction in CMT in response to aflibercept (mean CMT variation of −157 ± 171 μm versus −49.5 ± 39.9 μm; p < 0.01). Pre-switch CMT was a predictor of CMT reduction after switching (B = –0.945; confidence interval 95% –1.1; −0.76; p < 0.001).
The authors conclude that conversion to aflibercept for persistent DME resulted in functional and anatomical improvements and these outcomes were not influenced by previous bevacizumab exposure. Pre-switch CMT was a predictor of anatomical changes after aflibercept.
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