Microperimetric changes after intravitreal aflibercept injection in patients with diabetic macular edema

Objective: To determine whether visual acuity and anatomical improvement obtained with intravitreal aflibercept treatment in diabetic macular edema treatment are accompanied by healing of neuroretinal function. Material and Methods: A prospective interventional study involving 32 eyes of 32 patients with previously untreated diabetic macular edema was planned. Patients who met the criteria for admission to the study were followed up for a period of 6 months to receive a 5-month monthly intravitreal aflibercept injection. At baseline all patients underwent fluorescein angiography, optical coherence tomography, best-corrected visual acuity (BCVA) assessment, microperimetry and mfERG. . In all monthly visits, BCVA and OCT were performed. . In addition, microperimetry and mfERG recordings were obtained at month 0,3, and 6. Results: The mean initial BCVA was 0.73 logMAR while the mean 3rd month BCVA was 0.57 logMAR and the mean 6th month BCVA was 0.33 logMAR after treatment (p<0,001). Intraocular pressure change was not statistically significant (p=0,472). Initial SMT mean was 390.2 μm, mean 3 months was 289.7 μm, mean 6th SMT was 242.6 μm. It was observed that there was a statistically significant decrease between initial values and values of 3rd month and 6th month in SMT (p<0,001). In comparison with the initial values in the OCT segmentation analysis, the RNFL in all areas (central 1mm, inner ring, outer ring), GCL central area, IPL central and outer ring, INL in all areas, OPL central area, ONL In all areas, significant thinning was observed in all areas of the IRL (p <0.05 for each). Significant improvements in fixation patterns were observed in the 6th posttreatment microperimetry test. The macular sensitivity increased from 8.2 dB to 14.2 dB and was significant (p<0,001). The local deficit decreased from -10,3 dB to -5,5 dB and was significant (p<0,001). In the 6th month recordings of mfERG, the amplitude of N1 in central ring and amplitude of P1 in all rings amplitude were significantly increased (p <0.05 for each). In the 6th month recordings of mfERG, the implicit time of N1 in all rings and the implicit time of P1 in 2.nd, 3rd, 4th, 5th rings were significantly decreased (p <0.05 for each). Conclusion: It is seen that patients with intravitreal aflibercept injection in DME have significant improvements in OCT findings showing both anatomical and structural integrity and MP-1 and mfERG findings showing functional and neurophysiological improvement. Considering the effect of increasingly prominent neurodegeneration in DME patagonia, there is a need to evaluate the neurophysiological effects of intravitreal antiVEGF treatments by combining MP-1 and mfERG with OCT.