Comparison of the efficacy of aflibercept and ranibizumab after a 3-month loading dose in patients with diabetic macular edema



Aflibercept, Ranibizumab, Diabetic macular edema


Background/Aim: Diabetic macular edema (DME) is the main cause of visual loss in diabetic patients. Aflibercept and ranibizumab are among the most commonly used intravitreal agents in the DME. This study aims to compare the short-term anatomic and functional results of aflibercept and ranibizumab in the treatment of DME. Methods: This retrospective cohort study included newly diagnosed and treatment-naive DME patients. The patients were administered intravitreal aflibercept (IVA) or intravitreal ranibizumab (IVR) as a loading dose throughout 3 months. Pre-treatment and 1- and 3-month examinations were made of best corrected visual acuity (BCVA)and central macular thickness (CMT). After the treatment, the patients were classified in the 3rd month as those with good or poor response according to the early anatomic response. A good response to the treatment was considered the formation of foveal contour and full recovery of macular edema. Patients where macular edema was not fully resolved and/or foveal contour had not formed were classified as having poor response. Later, IVA and IVR were compared with each other in terms of response to treatment. Results: Evaluation was made of 67 eyes of 54 patients, comprising 31 (57.4%) females and 23 (42.6%) males with a mean age of 62.7 (7.3) years (range, 46-78 years). IVA was applied to 33 (49.3%) eyes and IVR to 34 (50.7%) eyes. In the IVA group, BCVA was determined as 0.75 (0.39) LogMAR pre-treatment, 0.53 (0.37) LogMAR at 1 month and 0.38 (0.30) LogMAR at 3 months (P<0.001 for each). CMT was measured as 400 (82) µm pre-treatment, 349 (95) µm at 1 month and 313 (79) µm at 3 months (P<0.001 for each). In the IVR group, BCVA was determined as 0.71 (0.34) LogMAR pre-treatment, 0.52 (0.34) LogMAR at 1 month and 0.39 (0.30) LogMAR at 3 months (P<0.001 for each). CMT was measured as 426 (92) µm pre-treatment, 365 (74) µm at 1 month and 323 (60) µm at 3 months (P<0.001 for each). A good response to treatment was determined in 24 eyes (72.7%) in the IVA group, and in 18 eyes (52.9%) in the IVR group. Although a good response to treatment was achieved at a higher rate in the IVA group, the difference was not statistically significant (P=0.09). Conclusion: Both visual and anatomic success was achieved with a 3-month loading dose in both the IVA and IVR groups. No statistically significant superiority was determined of one drug over the other in the 3-month period.


Download data is not yet available.


Kerner W, Brückel J, German Diabetes Association. Definition, Classification and Diagnosis of Diabetes Mellitus. Experimental and Clinical Endocrinology & Diabetes [Internet]. 2014 Jul 11 [cited 2019 Oct 14];122(07):384–6. Available from:

Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Research and Clinical Practice [Internet]. 2014 Feb [cited 2019 Sep 29];103(2):137–49. Available from:

Heier JS, Korobelnik J-F, Brown DM, Schmidt-Erfurth U, Do D V, Midena E, et al. Intravitreal Aflibercept for Diabetic Macular Edema: 148-Week Results from the VISTA and VIVID Studies. Ophthalmology [Internet]. 2016 Nov [cited 2019 Oct 14];123(11):2376–85. Available from:

Lee R, Wong TY, Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye and Vision [Internet]. 2015 Dec 30 [cited 2019 Oct 14];2(1):17. Available from:

Acan D, Calan M, Er D, Arkan T, Kocak N, Bayraktar F, et al. The prevalence and systemic risk factors of diabetic macular edema: a cross-sectional study from Turkey. BMC Ophthalmology [Internet]. 2018 Dec 12 [cited 2019 Oct 14];18(1):91. Available from:

Ip MS, Bressler SB, Antoszyk AN, Flaxel CJ, Kim JE, Friedman SM, et al. Diabetic Retinopathy Clinical Research Network. A randomized trial comparing intravitreal triamcinolone and focal/grid photocoagulation for diabetic macular edema baseline features. Retina. 2008;28(7):919–30.

Miller K, Fortun JA. Diabetic Macular Edema: Current Understanding, Pharmacologic Treatment Options, and Developing Therapies. Asia-Pacific Journal of Ophthalmology. 2018;7(1):28–35.

Ozkaya A, Alagoz C, Alagoz N, Gunes H, Yilmaz I, Perente I, et al. Dexamethasone implant in pseudophakic and nonglaucomatous subgroup of diabetic macular edema patients: A real life experience. European Journal of Ophthalmology. 2016;26(4):351–5.

Nguyen QD, Brown DM, Marcus DM, Boyer DS, Patel S, Feiner L, et al. Ranibizumab for diabetic macular edema: Results from 2 phase iii randomized trials: RISE and RIDE. Ophthalmology. 2012;119(4):789–801.

Wells JA, Glassman AR, Ayala AR, Jampol LM, Bressler NM, Bressler SB, et al. Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema Two-Year Results from a Comparative Effectiveness Randomized Clinical Trial. Ophthalmology [Internet]. 2016;123(6):1351–9. Available from:

Network DRCR, Elman MJ, Qin H, Aiello LP, Beck RW, Bressler NM, et al. Intravitreal ranibizumab for diabetic macular edema with prompt versus deferred laser treatment: three-year randomized trial results. Ophthalmology [Internet]. 2012 Nov [cited 2019 Oct 15];119(11):2312–8. Available from:

Diabetic Retinopathy Clinical Research Network, Wells JA, Glassman AR, Ayala AR, Jampol LM, Aiello LP, et al. Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema. New England Journal of Medicine [Internet]. 2015 Mar 26 [cited 2019 Oct 15];372(13):1193–203. Available from:

Klein BEK. Overview of epidemiologic studies of diabetic retinopathy. In: Ophthalmic Epidemiology [Internet]. 2007 [cited 2020 Apr 23]. p. 179–83. Available from:

Uçan Gündüz G, Ulutaş HG, Parmak Yener N, Yalçınbayır Ö. Corneal endothelial alterations in patients with diabetic macular edema. J Surg Med. 2021;5(2):120-123.

Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation For Diabetic Macular Edema: Early Treatment Diabetic Retinopathy Study Report Number 1. Archives of Ophthalmology. 1985;103(12):1796–806.

Stewart MW. Anti-VEGF therapy for diabetic macular edema. Current diabetes reports [Internet]. 2014 Aug [cited 2020 Apr 23];14(8):510. Available from:

Mitamura Y, Tashimo A, Nakamura Y, Tagawa H, Ohtsuka K, Mizue Y, et al. Vitreous levels of placenta growth factor and vascular endothelial growth factor in patients with proliferative diabetic retinopathy. Diabetes care [Internet]. 2002 Dec [cited 2020 Apr 23];25(12):2352. Available from:

Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. The New England journal of medicine [Internet]. 1994 Dec 1 [cited 2020 Apr 23];331(22):1480–7. Available from:

Shinoda K, Ishida S, Kawashima S, Wakabayashi T, Matsuzaki T, Takayama M, et al. Comparison of the levels of hepatocyte growth factor and vascular endothelial growth factor in aqueous fluid and serum with grades of retinopathy in patients with diabetes mellitus. The British journal of ophthalmology [Internet]. 1999 Jul [cited 2020 Apr 23];83(7):834–7. Available from:

Do DV, Schmidt-Erfurth U, Gonzalez VH, Gordon CM, Tolentino M, Berliner AJ, et al. The da VINCI study: Phase 2 primary results of VEGF trap-eye in patients with diabetic macular edema. Ophthalmology. 2011 Sep;118(9):1819–26.

Korobelnik JF, Do D V., Schmidt-Erfurth U, Boyer DS, Holz FG, Heier JS, et al. Intravitreal aflibercept for diabetic macular edema. Ophthalmology. 2014 Nov 1;121(11):2247–54.

Demir G, Kutlutürk G, Diyabetik Makula Ödemi Olan Hastalarda Aflibercept Tedavisinin Anatomik ve Görsel Sonuçlarının Değerlendirilmesi. Bosphorus Med J. 2021;8 (1):29-34

Erden B, Çakır A, Bölükbaşı S, Aslan AC, Elçioğlu MN. Comparison of Efficacy of Intravitreal Aflibercept and Ranibizumab in Treatment-naive Diabetic Macular Edema. European Archives of Medical Research. 2019;35(3):170–4.

Massin P, Bandello F, Garweg J, Hansen L, Harding S. Safety and Efficacy of Ranibizumab in Diabetic Macular Edema ( RESOLVE Study *). Diabetes Care. 2010;33(11):2399–405.

Mitchell P, Bandello F, Schmidt-Erfurth U, Lang GE, Massin P, Schlingemann RO, et al. The RESTORE study: Ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology. 2011 Apr;118(4):615–25.

Nowacka B, Kirkiewicz M, Mozolewska-Piotrowska K, Lubiński W. The macular function and structure in patients with diabetic macular edema before and after ranibizumab treatment. Documenta Ophthalmologica. 2016;132(2):111–22.

Fouda SM, Bahgat AM. Intravitreal aflibercept versus intravitreal ranibizumab for the treatment of diabetic macular edema. Clinical Ophthalmology [Internet]. 2017 Mar 23 [cited 2020 Apr 24];Volume 11:567–71. Available from:






Research Article

How to Cite

Ekizoğlu A, Çakmaklıoğulları M. Comparison of the efficacy of aflibercept and ranibizumab after a 3-month loading dose in patients with diabetic macular edema. J Surg Med [Internet]. 2021 Mar. 1 [cited 2022 Nov. 28];5(3):299-302. Available from: