Purpose The aim of this study was to assess the effect of the presence of epiretinal membrane (ERM) on the central macular thickness (CMT) and visual acuity in patients with diabetic macular edema (DME) treated with intravitreal aflibercept injections. Patients and methods A prospective interventional comparative study was carried out at the Department of Ophthalmology, Alexandria University, Alexandria, Egypt. It included 60 treatment-naïve patients, who were divided into two groups: 30 eyes with DME and ERM (study group) and 30 eyes with DME only (control group) that was confirmed with optical coherence tomography (OCT) with a CMT more than 300 μm. Only one eye per patient in each group was included in the analysis. All patients were subjected to full ophthalmic assessment. Then, they received three consecutive monthly intravitreal injections of 2.0 mg aflibercept and were followed up monthly for 6 months. Retreatment was performed when needed as in cases with persistent macular edema or recurrent macular edema documented by OCT. Spectral domain OCT for the assessment of the CMT was done in all patients at baseline, and at the 3 and 6-month follow up visits, and when needed in some cases during the follow-up. Results At baseline, no significant differences existed between the study group and the control group regarding age, sex, mean CMT, and mean best-corrected visual acuity (BCVA) ( P >0.05). The mean CMT, in the study group, improved significantly from a baseline value of 482.1±72.83 μm (range: 375–636 μm) to 443.2±79.22 μm (range: 297–597 μm) and 422.0±73.89 μm (range: 293–585 μm) at 3 and 6 months, respectively ( P <0.001). Similarly, the mean CMT, in the control group, improved significantly from a baseline value of 470.1±70.44 μm (range: 376–626 μm) to 330.0±78.12 μm (range: 246–501 μm) and 297.2±37.08 μm (range: 240.0–390 μm) at 3 and 6 months, respectively ( P <0.001). In the study group, the mean baseline BCVA was 0.66±0.13 LogMAR (range: 0.50–1.0 LogMAR) and significantly improved to 0.58±0.12 LogMAR (range: 0.40–0.80 LogMAR) at 3 months and to 0.54±0.13 LogMAR (range: 0.30–0.80 LogMAR) at 6 months ( P =0.002 and <0.001, respectively). The mean baseline BCVA, in control group, was 0.61±0.11 LogMAR (range: 0.50–1.0 LogMAR), that significantly improved to 0.33±0.14 LogMAR (range: 0.20–0.60 LogMAR) at 3 months, and to 0.28±0.10 LogMAR (range: 0.20–0.50 LogMAR) at 6 months ( P <0.001).The control group had significantly better BCVA and superior CMT reduction compared to the study group at the 3- and 6-month follow up visits ( P <0.001) with less number of injections (mean: 3.97±1.33 injections) needed than in the study group (mean: 5.77±0.57 injections) ( P <0.001). Conclusion Patients with DME and ERM showed lower treatment response to intravitreal injection of aflibercept regarding both visual (BCVA) and anatomical (CMT) outcomes than the patients with DME only.
Elnaggar et al. (Thu,) studied this question.