Clinical research conducted by ophthalmologists from the Retina Service of Wills Eye Hospital, Mid Atlantic Retina and the Department of Ophthalmology, University of Pennsylvania has shown significant anatomic improvement in patients with persistent DME when switched from bevacizumab / ranibuzumab to aflibercept. The retrospective interventional non-comparative case series study was performed to evaluate outcomes of patients with persistent DME and, according to the researchers, represents the first “real-world” assessment of aflibercept for treating DME in a cohort of eyes having previously received chronic anti-VEGF therapy. While the study was relatively small, the results presented may provide useful clinical insight into the practical management of challenging DME cases.
To be included in the study patients had to have a diagnosis of persistent DME, defined as “no reduction, incomplete resolution, or an increase in central subfield thickening by SD OCT, necessitating additional anti-VEGF therapy at the time of conversion.” The study included eyes that were treated with at least four consecutive injections of ranibizumab / bevacizumab administered under the same time intervals before being converted to at least two aflibercept injections. Participants in the study received an average of 13.7 bevacizumab / ranibizumab injections before switching to 4.1 aflibercept injections over 4.6 months of follow-up. The results showed that the mean logMAR visual acuity at the pre-switch visit was 0.60 ± 0.43 (Snellen equivalent, 20/80). This measurement improved to 0.55 ± 0.48 (Snellen equivalent, 20/70) by the second visit following conversion, equivalent to a mean logMAR change of -0.05 ± 0.22 (P = .12). In addition to the visual acuity measurements researchers found that the average central macular thickness (CMT) from the pre-switch SD-OCT scan was 459.2 ± 139.2 μm which improved to 348.7 ± 107.8 μm by the second visit following conversion.
While the study had a number of limitations, notably its size and retrospective nature which did not accommodate inclusion of a control group, the authors concluded that, “our results support the notion that converting patients with persistent DME to aflibercept results in improved anatomic outcomes and at least maintenance of vision. Future studies will be needed to determine whether these findings will be sustained or further improve with longer follow-up.”