Comparison of Retinal Nonperfusion in Diabetic Macular Edema Treated With Brolucizumab Versus Aflibercept: A KINGFISHER Trial Analysis.

In 30 seconds

This post hoc analysis of the multicenter, masked KINGFISHER clinical trial compared retinal nonperfusion over 52 weeks in 91 participants with diabetic macular edema treated monthly with brolucizumab or aflibercept. Nonperfusion was assessed using ultrawidefield fluorescein angiography at baseline, 24 weeks, and 52 weeks. Neither group had a statistically significant change in nonperfusion index across the posterior, peripheral, or pan-retinal zones; longitudinal changes also did not differ significantly between treatments (P > .05).

Key findings

• Neither treatment group showed statistically significant changes in nonperfusion index across retinal zones over 52 weeks (P > .05).
• Longitudinal nonperfusion index changes did not differ significantly between brolucizumab and aflibercept (P > .05).
• Mean nonperfusion indices increased slightly numerically from baseline at week 52, without statistically significant differences.

Why it matters

Retinal nonperfusion is an important vascular feature in diabetic macular edema. These findings indicate that, in this assessed cohort, monthly treatment with either agent was not accompanied by a measurable change in nonperfusion over 52 weeks. The results also suggest that improvement in this angiographic measure may not necessarily follow intensive VEGF inhibition, although the analysis cannot establish the underlying mechanism.

What to keep in mind

This was a post hoc analysis of a subset with available, gradable baseline angiography; only 91 cases were assessed, and follow-up was 52 weeks.