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Aflibercept in diabetic macular edema refractory to previous bevacizumab: outcomes and predictors of success

  • Retinal Disorders
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To evaluate functional and anatomical outcomes after aflibercept in patients with diabetic macular edema (DME) with poor response to bevacizumab.


We retrospectively reviewed patients with DME recalcitrant to bevacizumab who were switched to aflibercept between January and December 2015. All patients had a minimal follow-up of three months before the conversion and underwent at least three injections of bevacizumab. Functional outcome consisted in best corrected visual acuity (VA). Anatomical outcomes were demonstrated through central macular thickness (CMT) measured by optical coherence tomography.


Forty-nine eyes of 34 subjects were reviewed. Mean VA improved from 0.55 ± 0.32 logMAR to 0.46 ± 0.33 logMAR (p = 0.038). Mean CMT decreased from 473 ± 146 μm to 349 ± 85 μm (p < 0.001). Twelve eyes (24%) demonstrated absence of macular edema after aflibercept. Previous bevacizumab exposure did not correlate with different outcomes. The variation of VA in response to aflibercept was significantly superior in the group with poorer VA before the switch (mean variation of −0.097 ± 0.21 logMAR) when compared to eyes with VA < 0.4 logMAR (mean variation of +0.019 ± 0.090 logMAR; p = 0.036). The same scenario was verified for anatomical outcomes as eyes with poor vision before the switch (≥0.4 logMAR) achieved superior reduction in CMT in response to aflibercept (mean CMT variation of −157 ± 171 μm versus −49.5 ± 39.9 μm; p < 0.01). Pre-switch CMT was a predictor of CMT reduction after switching (B = –0.945; confidence interval 95% –1.1; −0.76; p < 0.001).


Conversion to aflibercept for persistent DME resulted in functional and anatomical improvements and these outcomes were not influenced by previous bevacizumab exposure. Pre-switch CMT was a predictor of anatomical changes after aflibercept.

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Correspondence to Manuel Sousa Falcão.

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Conflict of interest

Manuel S. Falcão has participated in advisory boards for Bayer and has received travel grants from Novartis, Alimera and Allergan. Susana Penas has participated in advisory boards for Bayer and has received travel grants from Novartis, Alimera and Allergan. Angela Carneiro has participated in advisory boards for Alcon, Bayer, Novartis, Alimera and Allergan. The other authors declare no conflicts of interest regarding the publication of this paper.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of Centro Hospitalar de São João/Faculty of Medicine of Porto University and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Laiginhas, R., Silva, M.I., Rosas, V. et al. Aflibercept in diabetic macular edema refractory to previous bevacizumab: outcomes and predictors of success. Graefes Arch Clin Exp Ophthalmol 256, 83–89 (2018).

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