Diabetic Macular Edema Treated With Intravitreal Aflibercept Injection After Treatment With Other Anti-VEGF Agents (SWAP-TWO Study)—12-Month Analysis

Abstract

Purpose: This article reports 12-month outcomes of patients with diabetic macular edema previously treated with other antivascular endothelial growth factor agents and transitioned to fixed dosing of intravitreal aflibercept (IAI). Methods: This prospective, single-arm study enrolled patients to receive IAI 2 mg (0.05 mL) every 4 weeks until optical coherence tomography demonstrated no fluid. Patients then received fixed dosing of IAI 2 mg once every 8 weeks through 12 months. Primary outcome was mean absolute change from baseline central subfield thickness (CST) at 12 months measured by optical coherence tomography. Results: Twenty eyes were enrolled. At baseline, best-corrected visual acuity was 70.0 letters, mean CST was 419.7 µm ± 92.0, superficial capillary perfusion density (CPD) was 46.0 ± 4.2%, and deep CPD was 50.8 ± 4.3%. At 12 months, the mean CST improved to 287.2 µm ± 80.2 ( P < .001), superficial CPD decreased to 43.6 ± 4.8% ( P = .04), and deep CPD decreased to 47.6 ± 4.8% ( P = .05). Conclusions: Patients who switched to fixed dosing of IAI demonstrated significant anatomic improvements in CST at 12 months. CPD values decreased significantly both in superficial and deep layers without significant changes in vision.

Optical Coherence Tomography Angiography of Macular Perfusion Changes after Anti-VEGF Therapy for Diabetic Macular Edema: A Systematic Review

“…A total of 16 studies that evaluated the effect of intravitreal anti-VEGF injections for DME on the macular perfusion using OCTA in the period between January 2016 and November 2020 were included [12,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]. Figure 3 shows the PRISMA flowchart summarizing the results of the search strategy and reasons for exclusion.…”

“…Golshani et al [44] prospectively evaluated patients with DME that switched from bevacizumab (95%) or ranibizumab (5%) to aflibercept using OCT and OCTA (SWAP-TWO Study). Patients received monthly aflibercept injections until OCT demonstrated no fluid, followed by fixed dosing once every two months through 12 months.…”

“…9 Journal of Diabetes Research conflicting results with 7 studies showing stable or improved macular perfusion following treatment [32][33][34][35][36][37][38], 7 studies showing worsening of macular perfusion following treatment [12,[39][40][41][42][43][44], and 2 studies showing conflicting results [45,46]. This could have been due to study design differences, differences in patients' characteristics and inclusion criteria, or methods of image analysis and vascular density quantification.…”