title: Conversion to aflibercept for diabetic macular edema unresponsive to ranibizumab or bevacizumab.
abstract: BACKGROUND
  The purpose of this study was to determine if eyes with diabetic macular edema (DME) unresponsive to ranibizumab or bevacizumab would benefit from conversion to aflibercept.
  
  
  METHODS
  This study was conducted as a retrospective chart review of subjects with DME unresponsive to ranibizumab and/or bevacizumab and subsequently converted to aflibercept.
  
  
  RESULTS
  In total, 21 eyes from 19 subjects of mean age 62±15 years were included. The majority of subjects were male (63%). The median number of ranibizumab or bevacizumab injections before switching to aflibercept was six, and the median number of aflibercept injections after switching was three. Median follow-up was 5 months after the switch. Mean central foveal thickness (CFT) was 453.52±143.39 mm immediately prior to the switch. Morphologically, intraretinal cysts were present in all cases. Mean CFT after the first injection decreased significantly to 362.57±92.82 mm (Wilcoxon signed-rank test; P<0.001). At the end of follow-up, the mean CFT was 324.17±98.76 mm (P<0.001). Mean visual acuity was 0.42±0.23 logMAR just prior to the switch, 0.39±0.31 logMAR after one aflibercept injection, and 0.37±0.22 log-MAR at the end of follow-up. The final visual acuity was significantly better than visual acuity before the switch (P=0.04).
  
  
  CONCLUSIONS
  Eyes with DME unresponsive to multiple ranibizumab/bevacizumab injections demonstrate anatomical and visual improvement on conversion to aflibercept.
authors.affiliation: Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA ; Vitreoretinal Department, Singapore National Eye Centre, Singapore.
authors.forename: Laurence S
authors.initials: LS
authors.lastname: Lim
authors.affiliation: Vitreoretinal Department, Singapore National Eye Centre, Singapore.
authors.forename: Wei Yan
authors.initials: WY
authors.lastname: Ng
authors.affiliation: Vitreoretinal Department, Singapore National Eye Centre, Singapore.
authors.forename: Ranjana
authors.initials: R
authors.lastname: Mathur
authors.affiliation: Vitreoretinal Department, Singapore National Eye Centre, Singapore.
authors.forename: Doric
authors.initials: D
authors.lastname: Wong
authors.affiliation: Vitreoretinal Department, Singapore National Eye Centre, Singapore.
authors.forename: Edmund Ym
authors.initials: EY
authors.lastname: Wong
authors.affiliation: Vitreoretinal Department, Singapore National Eye Centre, Singapore.
authors.forename: Ian
authors.initials: I
authors.lastname: Yeo
authors.affiliation: Vitreoretinal Department, Singapore National Eye Centre, Singapore.
authors.forename: Chui Ming Gemmy
authors.initials: CM
authors.lastname: Cheung
authors.affiliation: Vitreoretinal Department, Singapore National Eye Centre, Singapore.
authors.forename: Shu Yen
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Vitreoretinal Department, Singapore National Eye Centre, Singapore.
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.affiliation: Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
authors.forename: Thanos D
authors.initials: TD
authors.lastname: Papakostas
authors.affiliation: Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
authors.forename: Leo A
authors.initials: LA
authors.lastname: Kim
keywords: aflibercept; bevacizumab; diabetic retinopathy; macular edema; ranibizumab