Evaluation of contrast sensitivity and other visual function outcomes in diabetic macular edema patients following treatment switch to aflibercept from ranibizumab

摘要

Purpose: This study aims to investigate changes in contrast sensitivity (CS), visual acuity (VA), central retinal thickness (CRT), and vision-related quality of life in subjects with recalcitrant diabetic macular edema switched from long-term ranibizumab treatment to aflibercept. Patients and methods: In this prospective, investigator-masked, single-center study, 40 patients with persistent fluid, despite previous ranibizumab treatment, were switched to aflibercept with 5 consecutive monthly doses. The primary outcome was mean change from baseline to week 20 in Pelli–Robson CS. Secondary outcomes were mean change from baseline in best-corrected VA (BCVA), CRT, and National Eye Institute 25-Item Visual Function Questionnaire score. Results: Fifty eyes (baseline VA >6/30) were evaluated. A median of 21.1±11.9 (range 5–55) ranibizumab injections were administered prior to initiation of aflibercept. Mean CS improved from 1.40±0.14 log units at baseline to 1.46±0.15 log units at week 20 ( P 2=0.385, P 2=0.092, P =0.032). Conclusion: Switching from ranibizumab to aflibercept in patients with recalcitrant diabetic macular edema resulted in an improvement in all measured metrics, including CS, VA, and CRT. A majority of patients also indicated an improvement in vision-related quality of life. The finding of a stronger relationship between changes in CRT and CS compared with changes in CRT and BCVA suggests that the inclusion of CS as an endpoint may yield a more complete understanding of visual outcomes than that obtained by using VA alone.