Chen Yen-Yi, Chang Pei-Yao, Wang Jia-Kang
Department of Ophthalmology, Far Eastern Memorial Hospital, Taipei, Taiwan.
Department of Medicine, National Taiwan University, Taipei, Taiwan.
Asia Pac J Ophthalmol (Phila). 2017 May-Jun;6(3):250-255. doi: 10.22608/APO.2016186. Epub 2017 Apr 10.
To investigate the short-term efficacy and safety of intravitreal aflibercept in a case series of patients with diabetic macular edema (DME) refractory to ranibizumab or bevacizumab.
A retrospective chart review.
From September 2013 to March 2016, we identified patients with DME who developed resistance to bevacizumab or ranibizumab. Three monthly intravitreal aflibercept injections were administered in refractory cases. Nonresponse to aflibercept was defined as a paradoxical increase in central foveal thickness (CFT) and gain in best-corrected visual acuity (BCVA) of less than 1 line at 1 month after treatment compared with before aflibercept administration.
Out of a total of 72 eyes in 72 refractory patients, 42 eyes (58.3%) responded to aflibercept injections. The BCVA and CFT were 0.65 ± 0.32 logMAR and 438.5 ± 80.1 μm, respectively, before aflibercept treatment and significantly improved to 0.31 ± 0.17 logMAR (P = 0.0008) and 297.9 ± 19.1 μm (P = 0.0004), respectively, 1 month after 3 aflibercept injections in responders. No differences in baseline characteristics, including age, sex, glycosylated hemoglobin, serum creatinine, total cholesterol, lens status, grades of diabetic retinopathy, and CFT/BCVA before aflibercept management (P > 0.05), were observed between responders and nonresponders. There were 17 vitrectomized eyes in 30 nonresponders (56.7%), a significantly higher rate than among the 42 responders (0%; P = 0.00001).
Three monthly intravitreal aflibercept injections had benefit in nearly two thirds of cases with DME resistant to bevacizumab or ranibizumab over short-term follow-up. Vitrectomized eyes responded poorly to aflibercept treatment.
在一系列对雷珠单抗或贝伐单抗耐药的糖尿病性黄斑水肿（DME）患者中，研究玻璃体内注射阿柏西普的短期疗效和安全性。
回顾性病历审查。
2013年9月至2016年3月，我们确定了对贝伐单抗或雷珠单抗产生耐药性的DME患者。难治性病例每月进行3次玻璃体内注射阿柏西普。对阿柏西普无反应定义为与注射阿柏西普前相比，治疗1个月后中心凹厚度（CFT）反常增加且最佳矫正视力（BCVA）提高不到1行。
在72例难治性患者的72只眼中，42只眼（58.3%）对阿柏西普注射有反应。在有反应者中，阿柏西普治疗前BCVA和CFT分别为0.65±0.32 logMAR和438.5±80.1μm，在3次注射阿柏西普1个月后分别显著改善至0.31±0.17 logMAR（P = 0.0008）和297.9±19.1μm（P = 0.0004）。在有反应者和无反应者之间，未观察到包括年龄、性别、糖化血红蛋白、血清肌酐、总胆固醇、晶状体状态、糖尿病视网膜病变分级以及阿柏西普治疗前CFT/BCVA等基线特征的差异（P>0.05）。30例无反应者中有17只眼（56.7%）接受了玻璃体切除术，这一比例显著高于42例有反应者（0%；P = 0.00001）。
在短期随访中，每月3次玻璃体内注射阿柏西普对近三分之二对贝伐单抗或雷珠单抗耐药的DME病例有益。接受玻璃体切除术的眼对阿柏西普治疗反应不佳。
