Effect of Alternate Treatment with Intravitreal Anti-Vascular Endothelial Growth Factor and Steroid for Treatment-Naive Diabetic Macular Edema in a Real-Life Setting

Purpose: To assess if alternate treatment with intravitreal anti-vascular endothelial growth factor (VEGF) and corticosteroid injections can improve visual and anatomical outcomes of treatment-naive diabetic macular edema (DME) in a real-life setting. Methods: This single-center retrospective study included 71 treatment-naive DME eyes that received intravitreal anti-VEGF monotherapy (48 eyes, anti-VEGF group) or were alternately treated with intravitreal anti-VEGF and corticosteroid injections (23 eyes, alternate group). Results: During the 2-year follow-up period, the anti-VEGF group received an average of 5.7 injections, while the alternate group received 6.4 injections (P = 0.085). The alternate group demonstrated a 0.10 logMAR gain in visual acuity; the anti-VEGF group showed a 0.05 logMAR loss (P = 0.040). The alternate group achieved an 87.7-mu m reduction in central macular thickness; the anti-VEGF group achieved a 57.0-mu m reduction (P = 0.676). There was a visual loss >= 0.20 logMAR in 8.7% of the eyes in the alternate group and 33.3% of the eyes in the anti-VEGF group (P = 0.039). Cataract surgery was performed in 8.9% of the phakic eyes in the anti-VEGF group and 56.3% of the phakic eyes in the alternate group (P < 0.001). Conclusions: Alternate treatment with intravitreal anti-VEGF and corticosteroid injections demonstrated a more favorable visual outcome in treatment-naive DME eyes compared to intravitreal anti-VEGF monotherapy.