Abstract
Purpose To assess short-term functional and anatomical outcomes of refractory diabetic macular edema (DME) following a switch from ranibizumab or dexamethasone to aflibercept. Methods We included retrospectively eyes with persistent DME after at least 3 ranibizumab and/or one dexamethasone implant intravitreal injections (IVI). The primary endpoint was the mean change in visual acuity (VA) at month 6 (M6) after switching. Results Twenty-five eyes were included. Before switching to aflibercept, 23 eyes received a median of 9.5 ranibizumab, and among them, 6 eyes received one dexamethasone implant after ranibizumab and 2 eyes received only one dexamethasone implant. Baseline VA, before any IVI, was 52.9 ± 16.5 letters, and preswitch VA was 57.1 ± 19.6 letters. The mean VA gain was +8 letters (p = 0.01) between preswitch and M6. The mean central retinal thickness was 470.8 ± 129.9 μm before the switch and 303.3 ± 59.1 μm at M6 (p = 0.001). Conclusion Switching to aflibercept in refractory DME results in significant functional and anatomical improvement. The study was approved by the France Macula Federation ethical committee (FMF 2017-138).
Highlights
Diabetic macular edema (DME) is the leading cause of visual impairment in patients with diabetic retinopathy [1]
Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is currently one of the treatments of DME along with corticosteroids: in 2012, ranibizumab has been approved by the Food & Drug Administration (FDA) following the RISE and RIDE studies [4]; aflibercept has been approved for the treatment of DME in 2014 following the VIVID and VISTA phase 3 clinical trials [5]
23 eyes received a mean number of 9 ± 4.6 ranibizumab injections, and among them, 6 eyes received a mean number of 1.5 dexamethasone implants following ranibizumab treatment
Summary
Diabetic macular edema (DME) is the leading cause of visual impairment in patients with diabetic retinopathy [1]. The prevalence of diabetes is increasing worldwide. The prevalence of DME reaches about 5% [2, 3]. The cost associated with visual disability and treatment is high and makes DME a global health issue. DME is mainly due to an abnormal vascular permeability involving vascular endothelial growth factor (VEGF). Intravitreal anti-VEGF therapy is currently one of the treatments of DME along with corticosteroids: in 2012, ranibizumab has been approved by the Food & Drug Administration (FDA) following the RISE and RIDE studies [4]; aflibercept has been approved for the treatment of DME in 2014 following the VIVID and VISTA phase 3 clinical trials [5]. In France, aflibercept and dexamethasone are reimbursed by the healthcare system, respectively, since September and October 2015, while ranibizumab is reimbursed since 2012
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
