Ziv-aflibercept in Diabetic Macular Edema: Relation of Subfoveal Choroidal Thickness with Visual and Anatomical Outcomes.

Purpose: To evaluate the effects of intravitreal ziv-aflibercept injections (IVZ) on subfoveal choroidal thickness (SCT) as well as on central macular thickness (CMT) and on best corrected visual acuity (BCVA) changes in eyes with center-involved diabetic macular edema (CI-DME).

Methods: Fifty-seven eyes of 36 patients with CI-DME were included in this prospective interventional case series. Structural optical coherence tomography (OCT) and enhanced depth imaging OCT were performed at baseline followed by three monthly 1.25 mg IVZ injections. Changes of SCT, CMT, and BCVA at each follow-up session were assessed. The association between baseline SCT and its monthly changes with final visual and anatomical outcomes were also assessed.

Results: CMT at baseline, and at the first, second, and third month follow-up sessions were 396 $\pm$ 119, 344 $\pm$ 115, 305 $\pm$ 89, and 296 $\pm$ 101 μm, respectively (P-value $<$ 0.001). SCT at baseline, and at months one, two, and three were 236 $\pm$ 47, 245 $\pm$ 56, 254 $\pm$ 54, and 241 $\pm$ 54 μm, respectively (P-value $>$ 0.99). Corresponding figures for BCVA were 0.58 $\pm$ 0.29, 0.47 $\pm$ 0.31, 0.4 $\pm$ 0.24, and 0.37 $\pm$ 0.23 LogMAR, respectively (P-value $<$ 0.001). There was a statistically significant positive correlation between BCVA and CMT changes following IVZ injections (P-value $<$ 0.001). However, there were no significant correlations between SCT changes and visual acuity (VA) and CMT changes following IVZ injections.

Conclusion: IVZ improved visual outcomes and macular thickness profiles in patients with CI-DME. However, IVZ had no significant effect on SCT. Baseline SCT and its monthly changes had no association with visual and anatomical outcomes.