The effects of epiretinal membranes on the treatment outcomes of intravitreal aflibercept injection in diabetic macular edema: a real-life study

To evaluate the effects of epiretinal membrane (ERM) formation on the anatomic and functional results of subjects with diabetic macular edema (DME) who are receiving intravitreal aflibercept injections (IAIs).

This retrospective comparative study includes 29 eyes with DME (Group 1) and 43 eyes with DME and ERM (Group 2). After three consecutive monthly 2.0 mg IAIs, subjects received monthly follow-ups and retreatment was performed if needed. Corrected visual acuity (CVA), central macular thickness (CMT), and central macular volume (CMV) parameters were recorded tri-monthly, and the 36-month follow-up was designated the primary endpoint of the study.

There was no significant difference between groups when comparing the mean ages and male-to-female ratios (p > 0.05, for both). At the baseline, the mean CVA value was significantly worse (p = 0.002), and the mean CMT was significantly lower (p = 0.016) in Group 1, while there was no significant difference in terms of the mean CMV (p = 0.625). The mean number of IAIs was similar at the first (p < 0.102), second (p = 0.363), and third year (p = 0.850) follow-ups. The mean CVA was significantly worse, and CMT was significantly lower in Group 1 at most of the visits in the first half of the follow-up period (p < 0.05, for all), while there was no significant difference in the second half of the follow-up period. There was no significant difference between groups in terms of CMV at any visit (p > 0.05, for all).

Despite a similar number of IAIs needed, worse baseline clinical parameters are associated with poorer early- or mid-term outcomes. At the long-term follow-up, CVA and CMT became similar in DME independent of ERM.