Abstract
BackgroundTo compare the anatomical and visual outcomes in eyes with persistent diabetic macular edema (DME) after initial anti-VEGF therapy that were retreated continuously with the same anti-VEGF drug versus those that underwent two successive cycles of medication change in anti-VEGF drugs (double anti-VEGF switch).MethodsRetrospective review of eyes with persistent DME after 3 initial consecutive monthly anti-VEGF injections. This cohort was divided into two groups: Group 1 continued to receive the same initial anti-VEGF drug for at least 18 months while group 2 eyes were switched to different anti-VEGF medications twice. Group 1 was further subdivided into: Group 1A composed of eyes with less than 20% reduction in central subfield thickness (CRT) at month 3; and group 1B eyes with greater than or equal to 20% reduction in CRT. The percentage of eyes that achieved greater than 10 letters visual acuity (VA) gain or loss was recorded as the primary end point (through month 18 in group 1 and month 6 after 2nd switch in group 2).ResultsGroup 1A, 1B and group 2 were composed of 24, 18, and 14 eyes respectively. 34.7%, 56.2% and 36.3% of eyes achieved > 10 letters gain, while 4.3%, 6.2% and 27.2% of eyes lost > 10 letters in groups 1A, 1B, and 2, respectively. Analysis of the visual acuity (VA) letter change in this time interval revealed no significant difference between all groups (p = 0.11). Mean VA and CRT measurements at the primary endpoint in all groups were 0.5, 0.39, and 0.47 logMAR (p = 0.44), and 369.7, 279.9, 321 µm, (p = 0.01) respectively.ConclusionsThere was no difference in the visual outcomes between the two treatment strategies in eyes with persistent DME after 3 consecutive anti-VEGF injections. This may indicate that anti-VEGF switching—even if it is done twice—may have comparable clinical outcomes to sustained treatment with one agent.
Highlights
To compare the anatomical and visual outcomes in eyes with persistent diabetic macular edema (DME) after initial anti-VEGF therapy that were retreated continuously with the same anti-VEGF drug versus those that underwent two successive cycles of medication change in anti-VEGF drugs
There was no difference in the visual outcomes between the two treatment strategies in eyes with persistent DME after 3 consecutive anti-VEGF injections
Anti-VEGF injection has become first-line treatment for eyes with center-involving diabetic macular edema (CI-DME) and worsening visual acuity based on findings from DCRC. net and pivotal studies like RISE/RIDE, HARBOR and Protocol V [3, 4]
Summary
To compare the anatomical and visual outcomes in eyes with persistent diabetic macular edema (DME) after initial anti-VEGF therapy that were retreated continuously with the same anti-VEGF drug versus those that underwent two successive cycles of medication change in anti-VEGF drugs (double anti-VEGF switch). Laser photocoagulation was the standard treatment for DME until clinical trials demonstrated that intravitreal injection of pharmacological agents (steroids and anti-VEGF agents) can achieve significant anatomical and visual improvement in DME patients with less adverse effects. Anti-VEGF injection has become first-line treatment for eyes with center-involving diabetic macular edema (CI-DME) and worsening visual acuity based on findings from DCRC. There is a lack of consistent nomenclature for DME that does not fully resolve following initial anti-VEGF treatment, it is usually referred to as persistent diabetic macular edema (PDME) [8]
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