title: Aflibercept for Diabetic Macular Edema in Eyes Previously Treated With Ranibizumab and/or Bevacizumab May Further Improve Macular Thickness.
abstract: To evaluate the short-term anatomic and visual outcomes after aflibercept (Eylea; Regeneron, Tarrytown, NY) in eyes with diabetic macular edema (DME) previously treated with ranibizumab (Lucentis; Genentech, South San Francisco, CA) and/or bevacizumab (Avastin; Genentech, South San Francisco, CA).
  
  
  
  A single-center, retrospective, noncomparative study of 30 eyes in 23 patients with DME treated with prior ranibizumab and/or bevacizumab before switching to aflibercept.
  
  
  
  Eyes received an average of 16 prior injections (range: three injections to 31 injections; median: 17 injections). The mean central subfoveal thickness (CST) improved from 453 µm at the time of first anti-vascular endothelial growth factor (VEGF) injection (range: 304 µm to 686 µm; median: 429 µm), to 374 µm at the time of the switch to aflibercept (range: 267 µm to 547 µm; median: 361 µm; P = .02), to 332 µm after the first aflibercept injection (range: 242 µm to 545 µm; median: 318 µm; P < .001). Visual acuity improved after switching to aflibercept at the first follow-up visit (logMAR 0.40 [Snellen equivalent 20/50]) to logMAR 0.35 (Snellen equivalent 20/45) (P = .044).
  
  
  
  In eyes with persistent DME treated with ranibizumab and/or bevacizumab, switching to aflibercept may further improve macular thickness. Given the cost difference between the three drugs, a randomized trial evaluating a stepwise approach may be worthwhile. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:836-839.].
authors.forename: Chirag P
authors.initials: CP
authors.lastname: Shah
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Heier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000068258:Bevacizumab / Q000008:administration & dosage*; D003930:Diabetic Retinopathy / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D057915:Drug Substitution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008266:Macula Lutea / Q000473:pathology*; D008269:Macular Edema / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab / Q000008:administration & dosage*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage* / Q000037:antagonists & inhibitors; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012189:Retrospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C533178:aflibercept; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab