Intravitreal aflibercept effective for diabetic macular edema regardless of vitrectomy status
Intravitreal aflibercept (IVA) is effective for treating diabetic macular edema (DME) in eyes with or without prior pars plana vitrectomy (PPV), with similar visual and anatomical improvements and comparable treatment frequency in both groups, according to a study.
The study included 46 eyes, evenly divided between PPV and non-PPV groups. All patients received IVA injections according to DRCR.net Protocol T. After 6 monthly injections, eyes that did not respond to IVA were classified as refractory and switched to dexamethasone (DEX) implant, while non-refractory eyes continued IVA on an as-needed basis through 12 months. Best-corrected visual acuity (BCVA) and central subfield thickness (CSFT) were tracked throughout the study period.
Overall, 28.3% of eyes were refractory to IVA, with no significant difference between PPV and non-PPV groups. Among non-refractory eyes, the median number of IVA injections over 12 months was similar between groups. Both PPV and non-PPV eyes demonstrated significant improvements in BCVA and significant reductions in CSFT at 12 months. In refractory cases, DEX implantation led to a significant decrease in CSFT, though this anatomical improvement was not accompanied by a significant gain in visual acuity.
The findings indicate that IVA is effective for treating DME regardless of vitreous status, with comparable visual and anatomical outcomes and similar treatment frequency in vitrectomized and non-vitrectomized eyes. In eyes unresponsive to IVA, DEX implant provided meaningful anatomical improvement, although visual benefits were limited.
Reference
Thury G, Baranyi N, Rárosi F, et al. Efficacy of aflibercept in vitrectomized vs. non-vitrectomized eyes with diabetic macular edema: a prospective study. Int J Retina Vitreous. 2025;doi: 10.1186/s40942-025-00778-y. Epub ahead of print. PMID: 41366512.
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