Efficacy and Safety of Intravitreal Ziv-Aflibercept for  the Treatment of Patient with Diabetic Macula Edema  Refractory to Intravitreal Bevacizumab: A Case Series

Kanpirom Tangpontirak; Trakanta  Wannapanich; Yosanan  Yospaiboon; Supat  Sinawat; Suthasinee  Sinawat

Authors

Kanpirom Tangpontirak Department of Ophthalmology, Faculty of Medicine, Khon Kaen University
Trakanta Wannapanich Department of Ophthalmology, Faculty of Medicine, Khon Kaen University
Yosanan Yospaiboon Department of Ophthalmology, Faculty of Medicine, Khon Kaen University
Supat Sinawat Department of Physiology, Faculty of Medicine, Khon Kaen University
Suthasinee Sinawat Department of Ophthalmology, Faculty of Medicine, Khon Kaen University

Keywords:

bevacizumab, diabetic macular edema, persistent, refractory, ziv-aflibercept

Abstract

Purpose: To evaluate the safety and efficacy of intravitreal ziv-aflibercept (IVZ) injection in Thai patients with diabetic macular edema (DME) refractory to intravitreal bevacizumab (IVB).

Materials and Methods: Consecutive patients with refractory DME were treated with three monthly IVZ (1.25 mg/0.05 ml) injections. For patients who responded, a pro-re-nata protocol was used for recurrence or persistent DME, defined as central macular thickness (CMT) > 300 um. Outcome measures included best corrected visual acuity (BCVA), CMT and adverse events at 6 months. Comprehensive ophthalmic exams and optical coherence tomography (OCT) were performed at baseline and follow-up visits.

Results: Seven type 2 diabetic patients, mean age 56.71 ± 5.34 years, were included. The mean number of previous IVB injections was 5.71 ± 2.43. Patients were switched to IVZ 4-5 weeks after their last IVB injection. Mean BCVA improved from 0.46 ± 0.27 logMAR to 0.32 ± 0.17 logMAR (p = 0.018) at 3 months and 0.32 ± 0.13 logMAR (p = 0.001) at 6 months. Mean baseline CMT decreased from 512.71 ± 158.41 µm to 347.86 ± 122.61 µm (p = 0.012) at 3 months and 351.60 ± 117.71 µm (p = 0.029) at 6 months. After three loading injections, 2 eyes were non-responders. The mean number of IVZ injections was 4.6 ± 1.2. No intraocular inflammation, lens opacity progression, elevated
IOP, or retinal detachment was observed. No serious systemic complications were detected.

Conclusions: Intravitreal ziv-aflibercept is a safe and cost-effective treatment for DME refractory to IVB. It offers a valuable alternative, especially in resource-limited settings, but further large-scale, prospective studies are needed to confirm its efficacy and long-term safety

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