Study Finds 70% of DME Patients Can End Anti-VEGF Therapy After One Year

Anti-VEGF injections are a mainstay of management for various retinal conditions. With diabetic macular edema (DME), patients may receive injections on a fixed schedule, but a new study published in Ophthalmology Science assessed whether outcomes upon treatment cessation would be adequate and remain stable.The retrospective investigation included 81 eyes (62 patients) who met inclusion criteria and had a follow-up of ≥ 24 months; treatment interruption was defined as a treatment-fee interval of ≥ 25 weeks after the last injection, happening for any reason. With a maximum follow-up of up to 10 years and a median of five, patients received 22.6±14.9 (median 20) injections. One planned treatment cessation occurred in 70.4% of patients and four eyes experienced an unplanned interruption of treatment. Cessation was seen in 65.4% of eyes at a median of 42 weeks after treatment initiation for 106.2±110.4 (median 54) weeks. One eye (1.9%) had treatment cessation due to wishing to stop treatment against medical advice, was physician-driven in 38 eyes (71.7%) that had stable visual acuity despite persisting residual retinal fluid seen with OCT and was OCT-driven in 14 eyes (26.4%) with no intraretinal fluid on OCT. Overall, cessation was seen in 70% of DME eyes during the first year. Compared to other previous studies, patients in the current study may have perceived treatment burden as lower, given the medically supported treatment interruption under bi- to tri-monthly visits, given OCT and function remained stable. Photo: Jarett Mazzarella, OD. Click image to enlarge. Due to patients who had treatment cessation having no negative impact on long-term functional and morphological outcomes, the authors of the study write that “this calls for a discussion about a possible systematic assessment of disease stability by omitting a single injection in eyes with stable retinal fluid.”The authors further elaborate that treatment cessation was possible for almost two years (106 weeks), underscoring a robustness of stability under the persisting fluid-tolerant treatment protocol—mapping onto a relevant reduction in treatment burden for patients. After an average of 65 weeks, eyes became widely dry with tolerance of excess central retinal thickness of ≤10%, indicative of a generally favorable anatomic response after intensive treatment (mean 7.7 injections) in the first year. They also report a only a small 5% of patients being lost to follow-up over a mean of 5.7 years.Because of the nature of these results, the authors contend that “stable fluid may be tolerated which triggers a reconsideration of the best treatment approach. The currently fluid-driven protocol is not necessarily the ideal patient-supported one.”Instead, they offer the suggestion that “eyes with a supportable amount of persistent, but stable fluid (in our series, central subfield thickness up to 320µm) may benefit from an individualized strategy with ‘diagnostic’ treatment interruption.” They highlight that this strategy differentiates DME from non-proliferative age-related macular degeneration, in which only complete dryness indicates control of disease activity. Click here for the journal source. Saucedo L, Pfister IB, Schild C, Garweg JG. Treatment cessation in patients with diabetic maculopathy under intravitreal anti-VEGF therapy following a treat-and-extend protocol. Ophthalmol Sci. June 2, 2025. [Epub ahead of print].