Macular Ischemia Changes in Patients with Diabetic Macular Edema Treated with Aflibercept and Ranibizumab

Τhis study aims to assess changes in the fovea avascular zone (FAZ) in treatment naïve patients receiving aflibercept or ranibizumab injections for diabetic macular edema (DME). This is a prospective study recruiting patients with treatment-naïve DME. Best corrected visual acuity (BCVA) testing, OCT and OCT-angiography (OCTA) imaging were performed at baseline and 1 month after each injection. Injections of either aflibercept or ranibizumab were administered monthly for 6 consecutive months. FAZ in the superficial (SCP) and the deep capillary plexus (DCP) using OCTA was recorded for each visit. Fifty eyes from 50 patients with a mean age of 67.010.7 years were included in the study Twenty-five patients received aflibercept and 25 received ranibizumab. BCVA was 40.810.0 and increased to 52.17.9 ETDRS letters at the last visit (p<0.001). CRT was 295.634.0 at baseline and 247.929.7 at the last study visit (p<0.001). SCP FAZ was 350.679.5μm2 at baseline and 339.071.3μm2 after 6 monthly injections (p=0.132). DCP FAZ was 558.6199.0μm2 at baseline and 459.5156.1μm2 after 6 monthly injections (p<0.001). There was no effect of the choice of ranibizumab or aflibercept on DCP FAZ change (p=0.277). In conclusion, treatment with 6 monthly injections of ranibizumab and aflibercept led to an increase in BCVA and a decrease in CRT and DCP FAZ area. Both drugs led to an improvement in DCP ischemia.