title: The Effectiveness of Intravitreal Ranibizumab in Patients with Diabetic Macular Edema Who Have Failed to Respond to Intravitreal Bevacizumab.
abstract: OBJECTIVE
  To investigate the response to intravitreal ranibizumab after failure of intravitreal bevacizumab in patients with diabetic macular edema (DME).
  
  
  METHODS
  Demographics, visual acuity (VA), central macular thickness (CMT), and HbA1C were retrospectively collected from DME patients treated with second-line intravitreal ranibizumab at a tertiary hospital in 2012-2013 and followed for at least 3 months.
  
  
  RESULTS
  Twenty-two patients (26 eyes) were included in the study, with a mean (±SD) age of 66 ± 8.1 years and followed for an average of 28.36 months. The mean number of intravitreal bevacizumab injections was 7.3 ± 2.8, and of intravitreal ranibizumab injections 5.11 ± 2.4. After 3 ranibizumab injections, 57% of eyes showed improvement in VA. The change in VA was statistically significant (p = 0.044) in those eyes where the pretreatment acuity for the second-line therapy was <20/40 (logMAR 0.3). CMT decreased from 435.95 ± 83.28 to 373.69 ± 44.39 µm (p = 0.01). The number of ranibizumab injections was significantly correlated with the change in CMT (p = 0.037).
  
  
  CONCLUSIONS
  Intravitreal treatment with ranibizumab can be efficacious in eyes with DME that have failed to respond to bevacizumab.
authors.affiliation: Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel.
authors.forename: Rita
authors.initials: R
authors.lastname: Ehrlich
authors.forename: Idit
authors.initials: I
authors.lastname: Dan
authors.forename: Iris
authors.initials: I
authors.lastname: Deitch
authors.forename: Ruth
authors.initials: R
authors.lastname: Axer-Siegel
authors.forename: Karin
authors.initials: K
authors.lastname: Mimouni
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000627:therapeutic use*; D003930:Diabetic Retinopathy / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D058449:Intravitreal Injections; D008269:Macular Edema / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab / Q000627:therapeutic use*; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000187:drug effects / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab; D006442:Glycated Hemoglobin; D000069579:Ranibizumab; D042461:Vascular Endothelial Growth Factor A; C467484:VEGFA protein, human; C517652:hemoglobin A1c protein, human