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Intravitreal Ranibizumab or Aflibercept After Bevacizumab in Diabetic Macular Edema: Exploratory Retrospective Analysis

Authors Pessoa B, Malheiro L, Carneiro I, Monteiro S, Coelho J, Coelho C, Figueira J, Meireles A, Melo Beirão JN

Received 5 September 2020

Accepted for publication 5 November 2020

Published 22 January 2021 Volume 2021:15 Pages 253—260


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Bernardete Pessoa,1,2 Luísa Malheiro,1 Inês Carneiro,1 Sílvia Monteiro,1 João Coelho,1 Constança Coelho,3 João Figueira,4– 6 Angelina Meireles,1,2 João Nuno Melo Beirão1,2

1Ophthalmology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal; 2Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal; 3Genetics Laboratory, Institute of Environmental Health, Lisbon Medical School, University of Lisbon, Porto, Portugal; 4Centro Hospitalar e Universitário de Coimbra, Porto, Portugal; 5Faculty of Medicine of the University of Coimbra, Porto Portugal; 6Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal

Correspondence: Bernardete Pessoa
Centro Hospitalar e Universitário do Porto – Hospital de Santo António, Departamento de Oftalmologia, Largo Prof. Abel Salazar, Edifício Neoclássico, Porto 4099-001, Portugal
Tel +351 938469884

Aim: To evaluate the efficacy of switching from bevacizumab to ranibizumab or aflibercept in eyes with diabetic macular edema (DME) unresponsive to bevacizumab.
Methods: Single-center retrospective comparative study of patients with DME unresponsive to intravitreal bevacizumab that was switched to ranibizumab or aflibercept. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were analysed prior to and 4 months after the switch. Ocular coherence tomography (OCT) biomarkers were also analysed.
Results: Fifty-six eyes from 40 patients were included in the study, 33 eyes switched to ranibizumab and 23 to aflibercept. A significant median CFT decrease was observed in both groups (p< 0.001), with no between-group differences. BCVA gain was only significant in the ranibizumab group (p< 0.001). None of the pre-baseline or baseline parameters were associated with the response to ranibizumab or aflibercept.
Conclusion: In persistent DME unresponsive to bevacizumab, both anatomical and functional improvements were observed with ranibizumab whereas aflibercept only showed an anatomical improvement. NCT04018833.

Keywords: aflibercept, bevacizumab, diabetic macular edema, ranibizumab, refractory

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