Treatment of Diabetic Macular Edema with Aflibercept and Micropulse Laser (DAM Study)

Keyvan Koushan,1,2 Arshia Eshtiaghi,3 Pauline Fung,2 Alan R Berger,1,2 David R Chow1,2 1Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; 2Toronto Retina Institute, Toronto, Ontario, Canada; 3Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaCorrespondence: Keyvan Koushan, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto Retina Institute, Toronto, Ontario, Canada, Tel +1 416 356-4355, Email keyvan.koushan@uToronto.caPurpose: To investigate the safety and efficacy of micropulse (MP) macular laser in combination with intravitreal aflibercept for the treatment of center-involved diabetic macular edema (CI-DME).Methods: A single-blind prospective randomized controlled pilot trial was performed. In total, 30 eyes of 30 patients with CI-DME and best corrected visual acuity (BCVA) between, and including, 20/30 and 20/400 were enrolled. Enrolled eyes were randomized to 2 groups. Group 1 received intravitreal aflibercept injections (IVT-AFL) with sham laser. Group 2 received IVT-AFL with MP laser. Both groups were followed every 4 weeks for 48 weeks and retreatment was performed on pro re nata basis according to preset criteria. The main outcome measure was the average number of intravitreal injections for each group at 48 weeks. Secondary outcome measures included changes in BCVA and central macular thickness (CMT) at 24 and 48 weeks.Results: The average number of intravitreal injections at 48 weeks was similar between the groups (8.5± 3.3 in Group 1 vs 7.9± 3.6 in Group 2, p=0.61). After 48 weeks, both groups demonstrated an improvement in BCVA and CMT. However, the difference in improvement between the groups was not statistically significant (p=0.18 for BCVA and p=0.57 for CMT).Conclusion: Intravitreal injections of aflibercept led to improvements in BCVA and CMT at 24 and 48 weeks. Addition of MP laser to eyes in group 2 did not offer additional benefit in reducing treatment burden or improving CMT. Eyes that received MP laser showed a numerically greater improvement in BCVA, although this was not statistically significant.Clinicaltrials.gov Identifier: NCT03143192 March 8, 2017.Keywords: anti-VEGF, diabetic macular edema, micropulse laser, visual acuity