Effectiveness of aflibercept, ranibizumab, and Ozurdex for treating diabetic macular edema showing a suboptimal...

The purpose of the study was to compare two antivascular endothelial growth factor (anti-VEGF) agents (aflibercept and ranibizumab) with a corticosteroid implant (Ozurdex), administered as intravitreal injections to patients with persistent diabetic macular edema (DME) not responding to bevacizumab.

We conducted a retrospective study of 60 patients comprising men and women aged 18 and above who suffered from DME showing a suboptimal response after three intravitreal injections of bevacizumab and were referred to the ophthalmology department between January 2013 and June 2018. The following data were collected before therapy initiation and 1 month following three injections of anti-VEGF agents or steroids: age, sex, lens status, visual acuity (VA), intraocular pressure (IOP), and central foveal thickness (CFT).

One month following the third injection of anti-VEGF or steroid, VA and CFT were significantly improved; neither one of the injected medications showed clinical benefit over the others. However, IOP was increased after treatment with steroids compared to the other injections.

Resistance to anti-VEGF occurs in a substantial proportion of patients with DME. Few studies compare the efficacy of anti-VEGF agents and steroid therapy as second-line treatment for DME to determine the best treatment strategy. Injections of the examined drugs provide a similar clinical benefit. The increase in IOP following steroid injections compared to anti-VEGF agents is well known and has been previously described. It should be well considered before selecting second-line treatment.