Aflibercept for Diabetic Macular Edema in Eyes Previously Treated With Ranibizumab and/or Bevacizumab May Further Improve Macular Thickness

BACKGROUND AND OBJECTIVE: 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). PATIENTS AND METHODS: 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. RESULTS: 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 mu m at the time of first antivascular endothelial growth factor (VEGF) injection (range: 304 mu m to 686 mu m; median: 429 mu m), to 374 mu m at the time of the switch to aflibercept (range: 267 mu m to 547 mu m; median: 361 mu m; P = .02), to 332 mu m after the first aflibercept injection (range: 242 mu m to 545 mu m; median: 318 mu m; 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). CONCLUSIONS: 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.