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 Medica...

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Main Authors: Kashiwagi I, Nonaka R, Sasaki S, Yamamoto T, Yasuda K, Shimura M
Format: Article
Language:English
Published: Dove Medical Press 2025-04-01
Series:International Medical Case Reports Journal
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Online Access:https://www.dovepress.com/efficacy-of-aflibercept-8-mg-for-diabetic-macular-edema-in-vitrectomiz-peer-reviewed-fulltext-article-IMCRJ
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author Kashiwagi I
Nonaka R
Sasaki S
Yamamoto T
Yasuda K
Shimura M
author_facet Kashiwagi I
Nonaka R
Sasaki S
Yamamoto T
Yasuda K
Shimura M
author_sort Kashiwagi I
collection DOAJ
description 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 masahiko@v101.vaio.ne.jpIntroduction: 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
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publishDate 2025-04-01
publisher Dove Medical Press
record_format Article
series International Medical Case Reports Journal
spelling doaj-art-026a5dba810e4152a53ad643257b3efe2025-08-20T03:17:52ZengDove Medical PressInternational Medical Case Reports Journal1179-142X2025-04-01Volume 18465471101797Efficacy of Aflibercept (8 mg) for Diabetic Macular Edema in Vitrectomized Eyes Refractory to the Other Anti-VEGF Drug Therapies: A Report of Three CasesKashiwagi INonaka RSasaki SYamamoto TYasuda KShimura MIkumi 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 masahiko@v101.vaio.ne.jpIntroduction: 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 serieshttps://www.dovepress.com/efficacy-of-aflibercept-8-mg-for-diabetic-macular-edema-in-vitrectomiz-peer-reviewed-fulltext-article-IMCRJdiabetic macular edemaanti-vegfafliberceptvitrectomizedcase series
spellingShingle Kashiwagi I
Nonaka R
Sasaki S
Yamamoto T
Yasuda K
Shimura M
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
International Medical Case Reports Journal
diabetic macular edema
anti-vegf
aflibercept
vitrectomized
case series
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic diabetic macular edema
anti-vegf
aflibercept
vitrectomized
case series
url https://www.dovepress.com/efficacy-of-aflibercept-8-mg-for-diabetic-macular-edema-in-vitrectomiz-peer-reviewed-fulltext-article-IMCRJ
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