Efficacy of Aflibercept (8 mg) for Diabetic Macular Edema in Vitrectomized Eyes Refractory to the Other Anti-VEGF Drug Therapies: A Report of Three Cases

The efficacy of anti-VEGF therapy for DME in vitrectomized eyes is thought to be lower than that of DME in non-vitrectomized eyes. In this case, brolucizumab, which has a high anti-VEGF molar concentration, and faricimab, which has a low anti-VEGF molar concentration but anti-angiopoietin (Ang)-2 activity, were not effective, but aflibercept (8 mg), whose VEGF molar concentration was intermediate between the two, was effective. This may be due to the fact that aflibercept (8 mg) is a fusion protein rather than an antibody, has lower clearance than a small molecule like brolucizumab, and has a higher anti-VEGF molar concentration than faricimab. It is suggested that aflibercept (8 mg) may be effective for DME in vitrectomized eyes and may merit preferential administration in such cases.