Factors Affecting Intensive Aflibercept Treatment Response in Diabetic Macular Edema: A Real-World Study

Area of Science:

• Ophthalmology
• Endocrinology
• Nephrology

Background:

• Diabetic macular edema (DME) is a leading cause of vision loss in diabetic patients.
• Intensive treatment regimens are being explored to improve outcomes in DME.
• Understanding factors influencing treatment response is crucial for personalized medicine.

Purpose of the Study:

• To identify systemic and ocular factors affecting response to intensive aflibercept treatment for DME.
• To evaluate the real-world effectiveness of an intensive aflibercept regimen in DME patients.

Main Methods:

• Retrospective cohort study of 30 eyes from 23 DME patients.
• Intensive treatment: five monthly intravitreal aflibercept injections.
• Response assessed by central retinal thickness (CRT) and best-corrected visual acuity (BCVA).

Main Results:

• Significant improvements in CRT and BCVA were observed after loading doses (p < 0.05).
• 53.33% of eyes maintained CRT without further treatment over 12 months.
• Factors predicting suboptimal response included: longer diabetes duration (≥15 years), lower eGFR (<80 mL/min/1.73 m²), higher serum creatinine (≥0.95 mg/dL), higher potassium (≥4.7 mmol/L), and epiretinal membrane (ERM).

Conclusions:

• Intensive aflibercept therapy yields significant anatomical and visual gains in DME.
• Predictors of suboptimal response include specific systemic (diabetes duration, kidney function markers) and ocular (ERM) factors.
• These factors can help predict individual responses to intensive aflibercept treatment for DME.