Visual acuity and anatomical outcomes of intravitreal aflibercept treatment in patients with center-involved diabetic macular edema – a retrospective longitudinal cohort study

Ivana Todorović; Vesna Jakšić; Miroslav Stamenković; Lepša Žorić; Bojana Vučković; Biljana Trajković

doi:10.2298/VSP251114031T

Ivana Todorović Clinical Hospital Center “Zvezdara”, Eye Clinic, Belgrade, Serbia
Vesna Jakšić Clinical Hospital Center “Zvezdara”, Eye Clinic, Belgrade, Serbia
Miroslav Stamenković Clinical Hospital Center “Zvezdara”, Eye Clinic, Belgrade, Serbia; University of Belgrade, Faculty of Special Education and Rehabilitation, Belgrade, Serbia
Lepša Žorić University of Belgrade, †Faculty of Medicine, Belgrade, Serbia
Bojana Vučković Military Medical Academy, Clinic for Endocrinology, Belgrade, Serbia
Biljana Trajković Clinical Hospital Center “Zvezdara”, Eye Clinic, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP251114031T

Keywords: aflibercept;, diabetic retinopathy;, intravitreal injections;, macular edema;, ophthalmologic surgical procedures;, tomography, optical coherence;, treatment outcome;, vascular endothelial growth factors.

Abstract

Background/Aim. Center-involved diabetic macular edema (CI-DME) is a major cause of vision loss in diabetes mellitus, characterized by retinal thickening (1 mm) in the central foveal zone. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents, such as aflibercept, are widely used to treat retinal edema and improve visual outcomes. The aim of the study was to evaluate anatomical and functional changes of the retina following intravitreal administration of aflibercept in patients with CI-DME. Methods. This retrospective longitudinal cohort study included 70 eyes in 50 patients with optical coherence tomography (OCT)-confirmed CI-DME [with central foveal thickness (CFT) ≥ 350 µm and best-corrected visual acuity (BCVA) ≥ 0.6 Snellen], treated with three monthly aflibercept injections. BCVA, CFT, and macular volume (MV) were measured using the Optovue RTVue XR OCT device at baseline and after 1, 3, and 6 months of treatment. Results. Mean patient age was 64.63 ± 7.79 years. Hypertension was the most prevalent comorbidity (72.0%). Over the six-month follow-up period, significant reductions were observed in mean CFT (459.00 µm to 379.92 µm, p < 0.001) and MV (9.05 mm³ to 8.44 mm³, p < 0.001) values. Although BCVA showed modest improvement, it did not reach statistical significance. Anatomical improvements align with aflibercept’s inhibition of VEGF-A and placental growth factor, which reduced vascular permeability. Conclusion. Intravitreal aflibercept significantly decreases retinal thickness and MV in patients with CI-DME, confirming its anatomical efficacy. Functional visual improvement was limited, possibly due to chronic retinal damage. In order to clarify the effect of intravitreal aflibercept on visual outcomes, longer-term studies with larger patient cohorts are required.

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