COMPARISON OF BEVACIZUMAB AND AFLIBERCEPT IN TREATMENT OF DIABETIC MACULAR EDEMA

DR. SANA JAVED , DR FAROOQ AHMAD , DR KASHIF ALI , DR NABEEL AHMAD

Objective: To compare change in visual acuity letter score and central subfield thickness on optical coherence tomography between aflibercept and bevacizumab in DME.

Methods: A randomized controlled trial was conducted in the Department of Ophthalmology, Combined Military Hospital, Multan, Pakistan, from August 2025 to November 2025. Using consecutive sampling, 116 patients were randomized (1:1) to intravitreal aflibercept or bevacizumab. Adults aged 30 to 60 years with diabetes for at least 5 years, visual acuity 20/50 or worse, and OCT central macular thickness at least 300 µm were enrolled. Two aflibercept and four bevacizumab patients were lost to follow-up.

Results: Complete analysis included 110 eyes (aflibercept, n = 56; bevacizumab, n = 54). Baseline visual acuity did not differ (56.83 ± 10.17 vs 57.66 ± 9.72; p = 0.662). At month 2, mean visual acuity was 70.24 ± 10.17 versus 67.65 ± 11.78 letters (p = 0.220), while letter-score gain was greater with aflibercept (13.41 ± 5.92 vs 9.71 ± 5.93; p = 0.001). Baseline central subfield thickness was similar (p = 0.448). Month-2 central subfield thickness was lower with aflibercept (295.84 ± 98.15 vs 337.59 ± 102.30 µm; p = 0.031), with a larger reduction (p = 0.011).

Conclusion: Aflibercept produced greater visual acuity gain and larger central subfield thickness reduction than bevacizumab in center-involving DME.