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Pre-operative versus post-operative intravitreal aflibercept injection for management of DME in patients undergoing cataract surgery

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Abstract

Aim

The aim of this paper is to investigate the need of deferring cataract surgery until treating the co-existing diabetic macular edema (DME) using intravitreal (IVI) anti-vascular endothelial growth factor (anti-VEGF).

Methods

A prospective randomized interventional study included diabetic patients with visually significant cataract and DME. Patients were divided into 2 groups. Group A received three preoperative intravitreal (IVI) aflibercept injections with a monthly interval; the third injection was given intra-operatively. Group B received a single intra-operative injection, and two post-operative injections with a monthly interval. The primary outcome measure was the change in central macular thickness (CMT) at 1st and 6th month post-operative. The secondary outcome measures were best corrected visual acuity (BCVA) at same points and any documented adverse effects.

Results

Forty patients were enrolled in the study, 20 patients in each group. Means of CMT at 1 month post-operatively were significantly higher in group B than group A but no statistical difference at 6 months. There was no statistical difference between the 2 groups regarding BCVA at 1 or 6 months post-operatively. Compared with the baseline values, BCVA and CMT improved significantly after 1 and 6 months within both groups.

Conclusion

IVI of aflibercept given before cataract surgeries does not seem to have superior effect over postoperative injections in either macular thickness or visual outcomes. Hence, preoperative controlling of DME might not be mandatory in patients undergoing cataract surgery.

Clinical trial registration

The study is registered in clinical trial. Gov (NCT05731089).

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Authors and Affiliations

  1. Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Abeer M. Khattab & Sherein M. Hagras

  2. Department of Ophthalmology, Al-Hadi Clinic, Jabriya, Kuwait

    Abeer M. Khattab

  3. Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt

    Nancy M. Lotfy

Authors
  1. Abeer M. Khattab
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  2. Sherein M. Hagras
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  3. Nancy M. Lotfy
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Corresponding author

Correspondence to Sherein M. Hagras.

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Ethics approval

The study protocol was approved by the local Medical Ethics Committee in Kuwait, and it was in accordance with the principles of the declaration of Helsinki. The study is registered in clinical trial. Gov (NCT05731089).

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Informed written consent was obtained from all participants included in the study.

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The authors declare no competing interests.

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Khattab, A.M., Hagras, S.M. & Lotfy, N.M. Pre-operative versus post-operative intravitreal aflibercept injection for management of DME in patients undergoing cataract surgery. Graefes Arch Clin Exp Ophthalmol 261, 3223–3229 (2023). https://doi.org/10.1007/s00417-023-06138-6

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  • DOI: https://doi.org/10.1007/s00417-023-06138-6

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