Received: 27.06.2022; Accepted: 25.07.2022; Published on-line: 24.08.2022

Features of aflibercept plus hyperbaric oxygen therapy for diabetic macular edema

V. O. Drozdov,  V. M. Sakovych

Dnipro State Medical University; Dnipro (Ukraine)

TO CITE THIS ARTICLE: Drozdov VO,  Sakovych VM. Features of aflibercept plus hyperbaric oxygen therapy for diabetic macular edema. J.ophthalmol.(Ukraine).2022;4:18-22.   http://doi.org/10.31288/oftalmolzh202241822


Background: Diabetes mellitus (DM) is a disease characterized by chronic hyperglycemia and a cascade of pathological vascular alterations leading to diabetic retinopathy (DR) and diabetic macular edema (DME).

Purpose: To compare clinical characteristics in patients treated with aflibercept only and in those treated with aflibercept plus hyperbaric oxygen (HBO) therapy for DME.

Material and Methods: This open-label case-control study involved 91 type 2 diabetic (DM2) patients with non-proliferative DR and DME. Patients of the aflibercept-only group received a monthly intravitreous aflibercept at a dose of 2 mg for 5 months. Patients of the aflibercept-plus-HBO group received a monthly intravitreous aflibercept at a dose of 2 mg for 3 months. In addition, the latter patients received ten HBO sessions in the period between the first and the third injections. All patients underwent a routine general clinical and eye examination.

Results: At 3 months and 6 months, patients in the aflibercept-plus-HBO group showed improvements in visual acuity by 28.81% and 7.14%, respectively (р < 0.05), and retinal sensitivity to light by 24.44% and 19.5%, respectively (р < 0.05), with a reduction in the number of patients with DME by 84.56% and 51.13%, respectively (p < 0.05).

Conclusion: Intravitreal aflibercept with adjunctive HBO provides improved efficacy of treatment for DME in patients with DM2, with reductions in (a) the number and risk of intravitreal injections, (b) drug load on the patient, and (c) treatment duration.

Key words: non-proliferative diabetic retinopathy, diabetic macular edema, aflibercept, hyperbaric oxygen therapy



1.Li J, Welchowski T, Schmid M, et al. Prevalence, incidence and future projection of diabetic eye disease in Europe: a systematic review and meta-analysis. Eur J Epidemiol. 2020 Jan;35(1):11-23.

Crossref  PubMed

2.Linderman R, Cava J, Salmon A, et al. Visual Acuity and Foveal Structure in Eyes with Fragmented Foveal Avascular Zones. Ophthalmol Retina. 2020 May;4(5):535-44.

Crossref  PubMed

3.Holekamp NM. Overview of diabetic macular edema. Am J Manag Care. 2016 Jul;22(10 Suppl):s284-s291. 

4.Stefánsson E. Ocular oxygenation and the treatment of diabetic retinopathy. Surv Ophthalmol. 2006 Jul-Aug;51(4):364-80.

Crossref  PubMed

5.Browning D, Stewart M, Lee Ch. Diabetic macular edema. Evidence-based management.  Indian J Ophthalmol. 2018 Dec;66(12):1736-1750.

Crossref  PubMed

6.Lund-Andersen H. Mechanisms for monitoring changes in retinal status following therapeutic intervention in diabetic retinopathy. Surv Ophthalmol. 2002 Dec;47 Suppl 2:S270-7.


7.Shin ES, Sorenson CM, Sheibani N. Diabetes and retinal vascular dysfunction. J Ophthalmic Vis Res. 2014 Jul-Sep; 9(3):362-73. doi: 10.4103/2008-322X.143378.

8.Kodjikian L, Bellocq D, Mathis T. Pharmacological Management of Diabetic Macular Edema in Real-Life Observational Studies. Biomed Res Int. 2018 Aug 28;2018:8289253.

Crossref  PubMed

9.Korobelnik JF, Do DV, Schmidt-Erfurth U, et al. Intravitreal aflibercept for diabetic macular edema. Ophthalmology. 2014 Nov;121(11):2247-54.

Crossref  PubMed

10.Wells AJ, Glassman AR, Ayala AR, et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med. 2015 Mar 26;372(13):1193-203.

Crossref  PubMed

11.Baker CW, Glassman AR, Beaulieu WT, et al. DRCR Retina Network. Effect of Initial Management With Aflibercept vs Laser Photocoagulation vs Observation on Vision Loss Among Patients With Diabetic Macular Edema Involving the Center of the Macula and Good Visual Acuity: A Randomized Clinical Trial. JAMA. 2019 May 21;321(19):1880-1894.

Crossref  PubMed

12.Maalej A, Khallouli A, Choura R, et al. The effects of hyperbaric oxygen therapy on diabetic retinopathy: A preliminary study. J Fr Ophtalmol. 2020. 2020 Feb;43(2):133-8.

Crossref  PubMed

13.Petersmann A, Müller-Wieland D, Müller UA, et al. Definition, Classification and Diagnosis of Diabetes Mellitus. Exp Clin Endocrinol Diabetes. 2019 Dec;127(S 01):S1-S7.

Crossref  PubMed

14.Wilkinson CP, Ferris FL, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003 Sep;110(9):1677-82.




Corresponding Author: Drozdov Volodymyr,   vladimirandco@gmail.com

Author Contribution: Drozdov V.O. – data collection and research, data analysis and interpretation, manuscript preparation, writing, reviewing; Sakovich V.M. – concept development, design, manuscript preparation, writing, reviewing. All authors analyzed the results and agreed on the final version of the manuscript. 

Disclaimer: The opinions expressed and presented in the article are solely the author's and do not represent the official position of the foundation or institution.

Sources of support: the present research is a part of the research works performed at the Department of Ophthalmology at the Dnipro State Medical University: "Optimization of diagnosis and treatment methods for pathology of the retina and optic nerve in diabetes mellitus" (state registration number 0118U001275), completion period from 01.2018 to 12.2020 and "Improvement of diagnostics and pathogenetically justified treatment of dystrophic, vascular and inflammatory eye diseases" (state registration number 0121U111440), completion period from 01.2021 to 12.2024.

Conflict of Interest: all authors declare no conflict of interests 

Abbreviations: DM - Diabetes mellitus; DR - diabetic retinopathy; DME - diabetic macular edema; VEGF – vascular endothelial growth factor; HBO - hyperbaric oxygen; DM2 - type 2 diabetic; NPDR - non-proliferative diabetic retinopathy.