The impact of aflibercept combined with dexamethasone intravitreal implant on visual function and aqueous humor inflammatory responses in diabetic macular edema

Background: Diabetic macular edema (DME) is a predominant cause of visual impairment among patients. The concurrent administration of anti-vascular endothelial growth factor (VEGF) agents and corticosteroids may yield synergistic therapeutic benefits. Objective: In this study, we evaluated the efficacy and safety of aflibercept (AFL) in combination with dexamethasone (DEX) intravitreal implant for the treatment of DME. Methods: A total of 80 patients with DME admitted to a hospital from June 2022 to June 2024 were enrolled. 42 patients in the AFL group received monotherapy, and 38 patients in the AFL+DEX group received combination therapy. The best corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP) and aqueous humor inflammatory factors (IL-1?, MCP-1, IL-6, VEGF) were evaluated monthly. Efficacy was graded according to criteria at 4 months after treatment, and adverse events were recorded. Results: The findings revealed no statistically significant difference in the overall clinical efficacy rate between the AFL+DEX group and the AFL group (P>0.05). However, the AFL+DEX group demonstrated superior best-corrected visual acuity (BCVA) at 1, 3 and 6 months post-treatment, alongwith a significant reduction in central macular thickness (CMT) compared to the AFL group (P<0.05). Furthermore, aqueous humor analysis indicated markedly lower levels of inflammatory cytokines in the AFL+DEX group following treatment (P<0.05). In terms of safety profiles, the AFL+DEX group required fewer intravitreal injections (P<0.05). Conclusion: These findings underscore the potential of AFL combined with DEX intravitreal implant to enhance visual outcomes and modulate intraocular inflammation in DME patients, highlighting its substantial clinical utility.