Aflibercept with Micropulsed Laser Establishes Noninferiority in Treating DME

Single-dose aflibercept and micropulsed yellow laser (MPL) treatment has been found non-inferior to aflibercept monotherapy in treating diabetic macular edema (DME), according to a recent study.1

Previous research has noted the efficacy of MPL alone in stimulating biological repair mechanisms in eyes with DME while avoiding retinal damage or chorioretinal scarring. Additionally, it has been shown to result in greater reductions of foveal avascular zones and improved BCVA.2

Presented by Julian Villarreal, MD, Instituto Mexicano de Oftalmologia IAP, at the 43rd Annual Scientific Meeting of the American Society of Retinal Specialists in Long Beach, CA, this retrospective-prospective, analytical, descriptive study compared the efficacy of single-dose aflibercept with yellow MPL versus monotherapy aflibercept over a 6-month period.1

A collective 52 eyes were included, which were then divided into 2 main groups. The first, prospective group included 30 eyes from patients with DME and a central macular thickness (CMT) of ≤450 microns. These patients received a single-dose aflibercept injection, followed by a session of MPL 7-10 days after injection. Macular optical coherence tomography (OCT) was performed 4 weeks after MPL application and was continued every 4 weeks until week 24. MPL treatment zones were determined by the macular thickness map.1

The second, retrospective group included 28 eyes from patients with DME who had already received a loading dose of 3 intravitreal aflibercept injections given every 4 weeks or more over a 6-month period. These patients also had a baseline CMT of ≤450 microns. There were no significant differences in age or sex distribution between either group (P <.05).1

Baseline CMT was 353.5 +/- 72 microns in group A and 370 +/- 37.2 microns in group B. At the first post-treatment measurement, CMT had changed to 280.6 +/- 13 microns in group A and 279.4 +/- 13.5 microns in group B. Investigators noted no significant differences between baseline CMT and first post-treatment CMT between treatment groups (P = .294 and P = .827, respectively). However, significant differences were noted when comparing baseline CMT to the first post-treatment measurement within each group (P <.001 in both groups).1

Visual acuity improvement was only statistically significant in Group B (P = .002), and 10% of Group A required retreatment versus 14.29% in Group B. Neither group exhibited complications.1

Investigators noted the lower number of intravitreal injections in Group B on average compared to Group A (P <.001). A collective 80% of cases in Group A exhibited good anatomical responses, which the team noted may suggest that patients receiving fewer intravitreal injections may still achieve favorable outcomes with a CMT ≤450 microns.1

Ultimately, Villarreal and colleagues determined that the combination of single-dose aflibercept and MPL was non-inferior to aflibercept monotherapy in DME.1

“The availability of an alternative treatment to conventional therapy that demonstrates efficacy and a safe profile for the patient is of paramount importance,” Villarreal and colleagues wrote.1

References

1. 1: Villarreal J, Nishimura A. Effectiveness of Single-Dose Aflibercept Plus Micropulsed Yellow Laser vs Aflibercept Monotherapy for Diabetic Macular Edema. Poster presented at the 43rd Annual Scientific Meeting of the American Society of Retinal Specialists in Long Beach, CA, July 30-August 2, 2025.

2. 2: Sabal B, Wylęgała E, Teper S. Impact of Subthreshold Micropulse Laser on the Vascular Network in Diabetic Macular Edema: An Optical Coherence Tomography Angiography Study. Biomedicines. 2025;13(5):1194. Published 2025 May 14. doi:10.3390/biomedicines13051194