Document Type : Original Article
Author
Qurnah general hospital
Abstract
Aim
Method
Prospective study on patients with macular edema secondary to diabetes mellitus, retinal vein occlusion or wet AMD.
All the patients enrolled in the study had partial or no response to bevacizumab represented by mild or no improvement in macular thickness SD-OCT pictures or less than 2 lines improvement in best corrected visual acuity before switching to intravitreal aflibercept.
Results
40 patients selected regardless their age, sex, & diabetic control relatively, but all of them had macular edema resistant to repeated intravitreal bevacizumab injection anatomically & clinically.
Most of patients showed good response to aflibercept intravitreal injection, either from the first or repeated injection.
Conclusion
Aflibercept show good functional & anatomical improvement in macular edema not responding to frequent bevacizumab injection.
To evaluate the ability of aflibercept in the treatment of resistant macular edema after repeated intravitreal bevacizumab injection.
Keywords
Main Subjects
2. Scholl, Stefan, et al. "General pathophysiology of macular edema." European journal of ophthalmology 21.6_suppl (2011): 10-19.
https://doi.org/10.5301/EJO.2010.6050
3. Scholl, Stefan, Janna Kirchhof, and Albert J. Augustin. "Pathophysiology of macular edema." Ophthalmologica 224.Suppl. 1 (2010): 8-15.
https://doi.org/10.1159/000315155
4. Fogli, Stefano, et al. "Pathophysiology and pharmacological targets of VEGF in diabetic macular edema." Pharmacological research 103 (2016): 149-157.
https://doi.org/10.1016/j.phrs.2015.11.003
5. Urias, Elizabeth A., et al. "Novel therapeutic targets in diabetic macular edema: beyond VEGF." Vision research 139 (2017): 221-227.
https://doi.org/10.1016/j.visres.2017.06.015
6. Boyer, David S., et al. "Anti-vascular endothelial growth factor therapy for diabetic macular edema." Therapeutic advances in endocrinology and metabolism 4.6 (2013): 151-169.
https://doi.org/10.1177/2042018813512360
7. Klein, Ainat, and Anat Loewenstein. "Therapeutic monoclonal antibodies and fragments: bevacizumab." Retinal Pharmacotherapeutics 55 (2016): 232-245.
https://doi.org/10.1159/000431199
8. Cai, Siwei, et al. "The efficacy and safety of aflibercept and conbercept in diabetic macular edema." Drug Design, Development and Therapy (2018): 3471-3483.
https://doi.org/10.2147/DDDT.S177192
9. Ibrahim WS, Eldaly ZH, Saleh MG, Rateb MF, Aldoghaimy AH. Switching to Aflibercept in Diabetic Macular Edema after Unsatisfactory Response to Other Anti-vascular Endothelial Growth Factor Drugs. Korean J Ophthalmol. 2019 Apr;33(2):122-130. doi: 10.3341/kjo.2018.0037. PMID: 30977321; PMCID: PMC6462479.
https://doi.org/10.3341/kjo.2018.0037
10. Spooner, K., Hong, T., Wijeyakumar, W., & Chang, A. A. (2017). Switching to aflibercept among patients with treatment-resistant neovascular age-related macular degeneration: a systematic review with meta-analysis. Clinical Ophthalmology, 11, 161-177. https://doi.org/10.2147/OPTH.S125676
11. Queguiner F, Bezirganyan K, Courjaret JC, Curel L, Penaranda G, Righini Chossegros M. Impact of switching from ranibizumab to aflibercept on the number of intravitreous injection and follow up visit in wet AMD: results of real life ELU study. Int J Ophthalmol. 2020 Feb 18;13(2):252-256. https://doi.org/10.18240/ijo.2020.02.08
12. Spooner K, Fraser-Bell S, Hong T, Chang A. Prospective study of aflibercept for the treatment of persistent macular oedema secondary to retinal vein occlusions in eyes not responsive to long-term treatment with bevacizumab or ranibizumab. Clin Experiment Ophthalmol. 2020; 48: 53-60. https://doi.org/10.1111/ceo.13636