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  • Comprehensive Ophthalmology, Retina/Vitreous

    After 3 years of intensive, fixed-dose aflibercept for diabetic macular edema (DME), most patients can maintain visual gains with fewer injections, with 30% requiring no additional treatment.

    This finding from the ENDURANCE extension study underscores the importance of long-term clinical follow-up of patients with DME. While a substantial proportion of patients may not require ongoing intravitreal injections to maintain the benefits of earlier anti-VEGF therapy, most patients will continue to receive injections even 4 years following initial treatments. 

    The ENDURANCE extension study was designed to evaluate both the ability of an individualized re-treatment approach to maintain the benefits achieved with aflibercept during the 3-year VISTA DME trial, and the ability of macular laser to decrease treatment burden among patients requiring on-going aflibercept injections. Subjects enrolled in VISTA received either monthly or every other month aflibercept after 5 monthly doses, which led to rapid and sustained anatomic and visual improvement compared with macular laser. At the completion of VISTA, 60 patients elected to continue receiving aflibercept on an as-needed basis for 12 months.

    During the 12-month period, a mean of 4.5 injections were administered, while 18 patients (30%) required no further treatment. At the same time, mean visual acuity fluctuated by less than 1.5 letters from the baseline.

    Additionally, the authors found that macular laser did not reduce anti-VEGF treatment burden. Among the 37 patients (67%) who met the criteria for receiving macular photocoagulation at about 20 weeks, there were no significant differences in the frequency of treatment before or after laser surgery. 

    This study provides further support for a DME treatment paradigm that begins with intensive anti-VEGF therapy followed by a substantial reduction in visit and treatment burden afforded by an individualized re-treatment approach that is based on evidence of clinically relevant disease activity.