Clinical Brief: Aflibercept 8 mg for DME
Main Discussion Topics
- Treatment-Naive Case: A man aged 79 years with a 20-year diabetes history presents with untreated DME after recent cataract surgery.
- Loading Dose Protocol: Patient received aflibercept 8 mg every 4 weeks for 3 loading doses, showing gradual improvement in central subfield thickness and vision.
- Interval Extension: Successfully transitioned from 4-week loading doses to 8-week intervals, with continued improvement despite 1 missed appointment (11-week interval).
- Treatment Optimization: Further extended to 10-week intervals with restoration of foveal contour, resolution of ME, and vision improvement to 20/30.
Key Points for Physicians
- Anti-VEGF therapy remains the first-line treatment for most DME cases.
- Treatment response should be evaluated through both objective (optical coherence tomography) and subjective (visual acuity) measures.
- Working-age diabetic patients require strategies that balance rapid vision restoration with minimized treatment burden.
- Treatment intervals can be successfully extended while maintaining disease control.
Notable Insights
- Unintentional treatment extension (missed appointment) demonstrated continued improvement despite longer interval.
- Left eye with mild thickening but good vision (20/20) did not require treatment.
- Complementary treatment approaches may include steroids for nonresponders or cases with very florid ME.
- Aflibercept 8 mg allowed extension to 10 weeks with maintenance of anatomic and visual improvements.
Clinical Significance
Aflibercept 8 mg demonstrated effective control of DME with the ability to extend treatment intervals beyond the traditional 4-week protocol, potentially improving patient adherence and reducing treatment burden in the diabetic population.