Abstract
PTB Reports,2021,7,3,82-85.DOI:10.5530/PTB.2021.7.14Published:December 2021Type:Research ArticleAuthors:Abdullah AlHumaidan, Sitah AlZuman, Muhammad Haris Mazhar, Arwa A AlDahash, Wejdan AlMussalam, Hassan AlDhibi, Marco Mura, Loujain AlAbbasi, and Rajiv Khandekar Author(s) affiliations:Abdullah AlHumaidan*, Pharmacy Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Sitah AlZuman, Pharmacy Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Muhammad Haris Mazhar, Pharmacy Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Arwa A AlDahash, Pharmacy Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Wejdan AlMussalam, Pharmacy Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Hassan AlDhibi, Vitreo-retina Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Marco Mura, Vitreo-retina Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Loujain AlAbbasi, Diagnostic Imaging Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Rajiv Khandekar, Research Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Abstract:Aim: The purpose of this study is to see if switching from intravitreal Ranibizumab, an anti–Vascular Endothelial Growth Factor (anti-VEGF), to Aflibercept is evidence-based in the diabetic Saudi population. We compared the efficacy of three injections of the Aflibercept treatment regimen in diabetic macular edema (DME) cases refractory to Ranibizumab. Methods: In 2018, a retrospective single-arm cohort study was carried out. Cases of refractory DME were evaluated before and after three injections of Ranibizumab, as well as three Aflibercept treatment regimens. Optical Coherence Tomography (OCT) was used to investigate changes in Central Macular Thickness (CMT) (anatomic outcome). In addition, changes in the CMT and Best Corrected Visual Acuity (BCVA) (functional outcome) were assessed. Results: The cohort consisted of 74 eyes from 74 DME patients. As an anatomical indicator, the mean CMT decreased from 482±153 μ to 385.6±134.6 μ after three injections of Ranibizumab. In contrast, with Aflibercept treatment, the mean CMT decreased to 370.2±116.9 μ. The decrease in CMT was statistically significant [94.6μ (95% confidence interval (CI): 54.8; 134.3] (P 0.001). In addition, BCVA improved by two or more lines in 17 (23%) of the eyes treated with Aflibercept, remained unchanged in 40 (54%) of the eyes, and decreased in 17 (23%) of the eyes. Conclusion: The anatomic successes of both anti-VEGF (Ranibizumab and Aflibercept) treatment regimens in Saudi patients with DME are promising. The Aflibercept treatment regimen improves success in refractory DME cases, but the visual improvement appears to be limited. Keywords:Aflibercept, Anti Vascular Endothelial Growth Factors (Anti-VEGF), Diabetes., Diabetic Macular Edema (DME), Diabetic retinopathy, RanibizumabView:PDF (242.06 KB) PDF PDF Images The Best-corrected distance visual acuity in eyes with diabetic macular edema before and after anti-vascular growth factor treatment regimen.
Highlights
Diabetic Macular Edema (DME) impairs central vision due to disruption of the blood-retinal barrier, resulting in fluid accumulation within the retinal layers at the macula.[1,2] Anti-Vascular Endothelial Growth Factors (VEGF) such as Bevacizumab, Ranibizumab, and Aflibercept are more effective than laser in improving vision in DME patients.[3,4] VEGF is a key mediator of abnormal vascular permeability in DME.[5]
The findings of this study show the utility of switching from Ranibizumab to Aflibercept treatment in patients with refractory DME
central macular thickness (CMT) at the start of Aflibercept treatment was a determinant of success. This is the first study in a Saudi population that evaluates the role of Aflibercept treatment in eyes with DME that is refractory to Ranibizumab treatment
Summary
Diabetic Macular Edema (DME) impairs central vision due to disruption of the blood-retinal barrier, resulting in fluid accumulation within the retinal layers at the macula.[1,2] Anti-Vascular Endothelial Growth Factors (VEGF) such as Bevacizumab, Ranibizumab, and Aflibercept are more effective than laser in improving vision in DME patients.[3,4] VEGF is a key mediator of abnormal vascular permeability in DME.[5]. Previous research has found that intravitreal Aflibercept improves vision and reduces macular edema in patients who received anti-VEGF therapy.[11,12] To the best of our knowledge, no study has been conducted in the Saudi population on the effect of Aflibercept on DME in patients who were refractory to Ranibizumab treatment
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