Intravitreal Aflibercept for Patients With Diabetic Macular Edema Refractory to Bevacizumab or Ranibizumab: Analysis of Response to Aflibercept

Purpose: 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.

Design: A retrospective chart review.

Methods: 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.

Results: 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).

Conclusions: 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.