In Diabetic Macular Edema, Structural, Functional Metrics Can Help Determine Treatment Choice

Compared with laser control treatment, intravitreal aflibercept injection (IAI) is associated with a faster time to resolution and a higher rate of resolution of diabetic macular edema (DME), according to study results published in Ophthalmology Retina. In eyes treated with IAI, thicker baseline central subfield thickness (CST) and better baseline best corrected visual acuity (BCVA) is associated with longer time to and lower rate of DME resolution, according to the report. 

Researchers conducted a post-hoc analysis of VISTA (ClinicalTrials.gov Identifier: (NCT01363440) and VIVID (ClinicalTrials.gov Identifier: NCT01331681). Adult patients with type 1 or type 2 diabetes mellitus presenting with central DME involvement were eligible for study inclusion if the study eye had a BCVA between 73 and 24 letters (20/40 to 20/320 Snellen equivalent). Eyes received IAI 2 mg (n=558, q⁴ weeks, or q⁸ weeks after 5 monthly doses) or laser control (n=274).

In eyes treated with IAI, 59.0% and 74.1% of patients achieved DME resolution at weeks 52 and 100, respectively. In eyes treated with laser control, 28.0% and 47.3% of patients achieved DME resolution at weeks 52 and 100, respectively. Among the IAI group, median time to DME resolution was 33 weeks. Overall, the IAI group was 2.5-fold (95% CI, 2.0, 3.2) more likely to achieve DME resolution through week 100 compared with the laser control group.  

Higher baseline CST and better baseline BCVA was associated with lower rate of and longer time to DME resolution in the IAI group, while higher baseline CST was associated with lower rate of and longer time to DME resolution in the laser control group, according to the study. 

“These findings suggest CST and BCVA at presentation are 2 key factors for consideration when devising treatment strategies for management of eyes with DME,” according to the researchers. 

Study limitations included its post hoc design, study results are limited to eyes with moderate to severe nonproliferative diabetic retinopathy, a conservative definition of DME resolution was used for this study, and the analysis did not take into account the type of factors that can result in increasing CST, including intraretinal fluid, cystoid macular edema, and serous retinal detachment.

Disclosure: This research was supported by Regeneron Pharmaceuticals. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Valentim CCS, Singh RP, Du W, Moni H, Talcott KE. Time to Resolution of diabetic macular edema following treatment with intravitreal aflibercept injection or laser in VISTA and VIVID. Ophthalmol Retina. Published online July 14, 2022. doi:10.1016/j.oret.2022.07.004