Aflibercept versus Ranibizumab as a Second Line Therapy After Bevacizumab for Diabetic Macular Edema

• Published in: Clinical ophthalmology (Auckland, N.Z.) Vol. 15; pp. 2975 - 2980
• Main Authors: Alsaedi, Nasser G, Alselaimy, Ruba M, Alshamrani, Abdulaziz A, AlAjmi, Muhammed, Khandekar, Rajiv, Dhibi, Hassan Al, Abdullah, Abdulelah A. Al
• Format: Journal Article
• Language: English
• Published: Auckland Dove Medical Press Limited 01.01.2021; Taylor & Francis Ltd; Dove; Dove Medical Press
• Subjects: aflibercept; bevacizumab; Care and treatment; Diabetes; Diabetic retinopathy; Dropsy; Edema; Growth factors; Medical research; Medicine, Experimental; Monoclonal antibodies; Original Research; persistent dme; ranibizumab; Vascular endothelial growth factor; vegf switch; Visual impairment; Saudi Arabia; United States > US
• ISSN: 1177-5483; 1177-5467; 1177-5483
• DOI: 10.2147/OPTH.S316271

Purpose: To compare the visual and anatomic outcomes of aflibercept versus ranibizumab as a second line treatment for persistent diabetic macular edema (DME) after initial bevacizumab injections. Methods: In this retrospective cohort study, patients with center-involved DME of > 300 gm thickness after bevacizumab intravitreal injections in 2015-2019 were included. Those treated with ranibizumab (R) and aflibercept (A) were grouped as group R and group A, respectively. The change in central macular thickness (CMT) measured by optical coherence tomography (OCT) and the best corrected distance visual acuity (BCVA) before and after three-monthly anti-VEGF injections (anti-VEGF) in group R and group A were compared and reviewed. Results: There were 80 eyes of 75 patients in group R and 80 eyes of 72 patients in group A. The initial bevacizumab injections in group R and group A varied significantly (p = 0.01). The median change of the CMT after the three injections was not significantly different in group R (80 [micro]m) and group A (81.5 [micro]m) (p = 0.7). The improvement of BCVA in group R and group A was not significant (p = 0.5). Dry macula was noted in 1 vs 14 eyes in group R vs group A. Conclusion: After treating refractory DME with initial bevacizumab injections, 3 injections of either aflibercept or ranibizumab had similar anatomic and functional outcomes. Aflibercept achieved dry macula in more eyes with refractory DME compared to ranibizumab. Keywords: aflibercept, bevacizumab, persistent DME, ranibizumab, VEGF switch, vascular endothelial growth factor