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

Ikumi Kashiwagi, Ryota Nonaka, Shotaro Sasaki, Takuto Yamamoto, Kanako Yasuda, Masahiko Shimura Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, JapanCorrespondence: Masahiko Shimura, Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, 193-0998 1163 tate-machi, Hachioji, Tokyo, Japan, Tel +81-42-665-5611, Fax +81-42-665-1796, Email [email protected]: To report the efficacy of aflibercept (8 mg) for diabetic macular edema (DME) in vitrectomized eyes refractory to other anti-VEGF drug therapies.Case Presentations: This was a single-center retrospective case series. Three eyes with DME that developed after vitrectomy for diabetic vitreous hemorrhage were resistant to other anti-vascular endothelial growth factor (VEGF) drugs but improved with aflibercept (8 mg). Prior to treatment with aflibercept (8 mg), 2 eyes received multiple injections of faricimab and brolucizumab, and 1 eye received multiple injections of faricimab, but none of the 3 eyes showed morphological or functional improvement. Subsequently, aflibercept (8 mg) was administered, and a single dose of aflibercept resulted in marked improvement in all cases.Conclusion: 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.Keywords: diabetic macular edema, anti-VEGF, aflibercept, vitrectomized, case series