Predictive value of uninterrupted dry macula duration for discontinuation of anti-VEGF therapy in diabetic macular edema

Successful discontinuation of intravitreal anti-vascular endothelial growth factor (VEGF) injections for diabetic macular edema (DME) without recurrence is rarely achieved. This investigator-initiated retrospective study examined whether maintaining uninterrupted dry macula, without even brief recurrences, using anti-VEGF injections is correlated with subsequent treatment discontinuation. Data were collected from 15 Japanese DME patients who completed two years of brolucizumab or aflibercept treatment in the KESTREL phase III trials and were followed for ≥ 3 years. Treatment discontinuation was defined as no anti-VEGF injections for ≥ 3 years without DME recurrence after KESTREL completion. Dry macula was defined using central macular thickness (CMT) thresholds between 270 and 320 μm. A moderate correlation between the duration of uninterrupted dry macula and treatment discontinuation was observed at a CMT threshold of ≤ 290 μm (r = 0.567, p = 0.028). No such correlation was observed for the cumulative dry duration that included brief recurrences. Firth's logistic regression indicated that maintaining a dry macula at ≤ 280 μm for 7.34 months (95% CI: 3.62-11.07) was associated with a 50% probability of treatment discontinuation. Maintaining long-term uninterrupted dry macula with anti-VEGF agents may be associated with treatment discontinuation in DME. Confirmation in larger prospective studies would be warranted.