Repeated vitreal injection of and-vascular endothelial growth factor for incremental hard exudates in the fovea in a case of diabetic macular edema

Purpose: To report a case of diabetic macular edema with incremental foveal hard exudate treated by repeated vitreal injection of aflibercept. Case: A 73-year-old male was referred to us for impaired vision in both eyes. He had been treated for diabetes mellitus in the past 20 years. Findings and Clinical Course: Corrected visual acuity was 0.3 right and 0.6 left. Central macular thickness (CMT) was 529 μm right and 339 μm left. Both eyes started treatment with vitreal injection of aflibercept. After 3 sessions, the right eye showed visual acuity of 0.6 with CMT of 314 μm. followed by slowly progressive deposit of hard exudates around the fovea. The right eye received 8 sessions of aflibercept injection during the ensuing 10 months associated with further increase of hard exudates. After a total of 17 injections during 19 months, hard exudates around the fovea disappeared with visual acuity of 0.9 and CMT of 241 μm. Visual acuity in the left eye improved to 0.9 with CMT of 263 μm after 3 sessions of treatment. Conclusion: Repeated vitreal injection of aflibercept induced improved vision and disappearance of slowly progressive hard exudates around the fovea in a case of diabetic maculopathy.