Study: Aflibercept Superior to Ranibizumab in Inflammation Control after Vitrectomy

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Although both anti-VEGFs maintain a consistent safety profile, aflibercept shows a more pronounced short-term inhibitory effect on inflammation after vitrectomy for diabetic retinopathy.

Vitreous cavity injections of both ranibizumab and aflibercept effectively reduced the expression of vascular-related factors in the atrial fluid of patients with diabetic retinopathy, improving outcomes after 25G vitrectomy, according to a recent study.1

In the analysis, each treatment demonstrated a consistent safety profile after vitrectomy – the results, however, showed aflibercept had a more significant inhibitory effect on the inflammatory response in patients in the short term compared to ranibizumab.

“It is presumed that aflibercept is preferred for future interventions when performing vitrectomy for diabetic retinopathy,” wrote the investigative team, led by Zhenyuan Yang, MD, department of ophthalmology, Sunshine Union Hospital.

Alongside the growing global prevalence of diabetes, diabetic retinopathy, a common and serious complication of diabetes, is currently one of the primary factors leading to acquired blindness in patients. Estimates suggest the incidence of retinopathy is linked to the duration of diabetes – a retinopathy incidence of 25% at 5 years of diabetes reaches 75-90% after 15 years of the disease.2

There have been few studies investigating the difference in the effectiveness of anti-vascular endothelial growth factor (VEGF) therapies in 25G vitrectomy. In this analysis, Yang and colleagues looked at the effect of ranibizumab and aflibercept in vitrectomy to provide more reliable guidance for future treatment of retinopathy.

A total of 94 patients with diabetic retinopathy from August 2020 to February 2022 were selected for the study. Inclusion criteria included a diagnosis of diabetic retinopathy confirmed by fundus fluorescence angiography, monocular lesions, vision loss with fundus manifestations, the presence of indications for vitrectomy, and treatment with anti-VEGF. Participants were divided into the ranibizumab 0.05 mL (n = 47) and aflibercept 0.05 mL (n = 47) groups, with each agent injected into the vitreous before 25G vitrectomy.

Levels of VEGF and pigment epithelium-derived factor (PEDF) in pre- and post-injection atrial fluid were compared between groups, while investigators recorded the operative time, intraoperative bleeding, and the occurrence of medically induced fissures. The analysis also recorded the expression of best-corrected visual acuity (BCVA), central macular thickness (CMT), and inflammatory factors before and after the procedure.

There were no statistically significant differences between the aflibercept and ranibizumab groups regarding age or gender. Before and after injection, the differences in levels of VEGF and PEDF between groups were not statistically significantly different (P >.05).

After injection, VEGF levels decreased to 83.32 ± 10.24 pg/mL and PEDF increased to 256.54 ± 45.04 pg/mL in the ranibizumab group. In the aflibercept group, VEGF levels decreased to 84.77 ± 11.45 pg/mL and PEDF increased to 259.23 ± 60.75 pg/mL after injection.

The differences between the ranibizumab and aflibercept groups regarding operative times were statistically insignificant (P >.05). In addition, the difference in the ratio of intraoperative bleeding rate and the incidence of medically induced fissure between both groups was not statistically significant (P >.05).

Differences in both BCVA and CMT between groups at the preoperative stage, 2 months, and 6 months were also not statistically obvious (P >.05), with both measures decreasing at the 2-month mark. There were no further changes in BCVA at 6 months, while CMT decreased in both groups (P <.05).

The comparison between levels of inflammatory factors between groups revealed no statistically significant differences at baseline and 6 months (P >.05). However, at 2 months after surgery, measures of IL-6, IL-8, and MMP-9 were lower in the aflibercept group than in the ranibizumab group (P <.05), suggesting a superior inhibitory effect on inflammation in the short-term.

Investigators noted the comparison of adverse reactions and prognosis of both treatment groups revealed no difference in the incidence of adverse reactions between the two groups (P >.05).

“[This] indicates that both ranibizumab and aflibercept have a high safety profile and have a stable effect on the prevention of disease recurrence after diabetic retinopathy treatment, which also suggests [they] have the potential to become diabetic retinopathy preventive drugs in the future, but their optimal doses still need to be confirmed by further studies,” investigators wrote.


  1. Ma X, Ma N, Zhang Q, Wang Y, Sun H, Yang Z. Effectiveness Differences of Ranibizumab and Aflibercept Action in the Treatment of Diabetic Retinopathy [published online ahead of print, 2023 Oct 13]. Altern Ther Health Med. 2023;AT8272.
  2. Vujosevic S, Aldington SJ, Silva P, et al. Screening for diabetic retinopathy: new perspectives and
    challenges. Lancet Diabetes Endocrinol. 2020;8(4):337-347. doi:10.1016/S2213-8587(19)30411-5