Case 2: Treatment-Naive DME with Gradual Visual and Anatomical Gains Using Aflibercept 8 mg

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.