McCloskey Clare F, Mongan Ann-Marie, Chetty Shivona, McAteer Darren M J, Quinn Shauna M
Ophthalmology Department, Sligo University Hospital, Sligo, Ireland.
Ophthalmol Ther. 2018 Jun;7(1):173-183. doi: 10.1007/s40123-018-0123-0. Epub 2018 Mar 5.
To determine visual and anatomical outcomes of diabetic macular oedema (DMO) patients in a tertiary centre following conversion to aflibercept having been refractory to previous treatment with bevacizumab/ranibizumab.
A retrospective case series of patients with a diagnosis of DMO undergoing aflibercept intravitreal therapy for at least 6 months who had previous treatment with three consecutive bevacizumab/ranibizumab injections pre-switch. Exclusion criteria included other procedures affecting visual outcome performed within the treatment period. Outcomes measured included visual acuity (VA), central macular thickness (CMT) and injection frequency.
Eighteen eyes of 13 patients were included. Mean VA pre-switch was 61.5 ± 13.8 letters and CMT was 433.2 ± 101.4. Mean number of prior bevacizumab/ranibizumab treatments was 11.3 ± 7.2. Mean follow-up post-switch was 22.5 months (SD 7.9). Mean VA improved from baseline by 4.8 letters at 6 months (p = 0.005), by 6.1 letters at 12 months (p = 0.006), by 7.9 letters (p = 0.004) at 18 months and by 6.4 letters (p = 0.1) at 24 months. Mean CMT decreased from baseline by 108.6 μm at 6 months (p = 0.01), 117.7 μm at 12 months (p = 0.0003), 158.0 μm at 18 months (p = 0.005) and by 123.3 μm at 24 months (p = 0.02).
Switching to aflibercept in treatment-resistant DMO produces significant improvements in visual and anatomical outcomes, with eventual maintenance of VA levels.
确定在三级医疗中心，之前使用贝伐单抗/雷珠单抗治疗无效后改用阿柏西普治疗的糖尿病性黄斑水肿（DMO）患者的视力和解剖学结局。
一项回顾性病例系列研究，纳入诊断为DMO且接受阿柏西普玻璃体腔注射治疗至少6个月的患者，这些患者在改用阿柏西普之前连续接受过三次贝伐单抗/雷珠单抗注射治疗。排除标准包括在治疗期间进行的其他影响视力结局的手术。测量的结局包括视力（VA）、中心黄斑厚度（CMT）和注射频率。
纳入13例患者的18只眼。改用阿柏西普前的平均视力为61.5±13.8字母，CMT为433.2±101.4。之前接受贝伐单抗/雷珠单抗治疗的平均次数为11.3±7.2。改用阿柏西普后的平均随访时间为22.5个月（标准差7.9）。6个月时平均视力较基线提高4.8字母（p = 0.005），12个月时提高6.1字母（p = 0.006），18个月时提高7.9字母（p = 0.004），24个月时提高6.4字母（p = 0.1）。6个月时平均CMT较基线降低108.6μm（p = 0.01），12个月时降低117.7μm（p = 0.0003），18个月时降低158.0μm（p = 0.005），24个月时降低123.3μm（p = 0.02）。
对于耐药性DMO患者，改用阿柏西普可显著改善视力和解剖学结局，并最终维持视力水平。
