Intravitreal ziv-aflibercept reduces central macular thickness and improves visual acuity in DME and RVO

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Archivos de la Sociedad Espanola de Oftalmologia Published June 7, 2026 Medically reviewed June 7, 2026 Study authors: Munayco-Guillén F, García-Roa M, Vázquez-Membrillo M, Pichardo-Rodríguez R PubMed ↗ DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Note that intravitreal ziv-aflibercept reduces macular thickness and improves vision in DME and RVO patients.

This systematic review and meta-analysis evaluated the efficacy of intravitreal ziv-aflibercept (ZA-IV) for patients with diabetic macular edema (DME) and macular edema secondary to retinal vein occlusion (RVO). The analysis included 5 randomized controlled trials and 8 observational studies.

In patients with DME, RCTs showed a reduction in central macular thickness (CMT) of 105 μm (95% CI: -129.8 to -80.3) and a LogMAR improvement of 0.29 (95% CI: -0.36 to -0.21). Observational studies for DME reported a CMT reduction of 108 μm (95% CI: -133 to -83.1) and a LogMAR improvement of 0.2 (95% CI: -0.26 to -0.14). For RVO, RCTs showed a substantial CMT reduction of 230 μm (95% CI: -367 to -94), while observational data for EMSOV showed a GMC reduction of 160 μm (95% CI: -257 to -64) and a LogMAR improvement of 0.2 (95% CI: -0.26 to -0.14).

The authors noted heterogeneity in observational studies ranging from 34% to 74%. No serious ocular or systemic adverse effects were reported, suggesting the treatment is potentially safe for these conditions. Clinical evidence supports its use for treating DME and RVO, though results from observational data should be interpreted with caution due to higher heterogeneity.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

PMID41812726

View Original Abstract ↓

BACKGROUND AND OBJECTIVE: Intravitreal Ziv-Aflibercept (ZA-IV) is a recombinant fusion protein used to treat macular diseases. Several studies have demonstrated its efficacy and safety. The objective was to evaluate the efficacy and safety of ZA-IV in the treatment of diabetic macular edema (DME) and macular edema secondary to retinal vein occlusion (RVO). MATERIALS AND METHODS: Systematic review with meta-analysis (PROSPERO: CRD42024542788), with searches in PubMed, EMBASE, and Web of Science up to April 2024. Observational studies and randomized controlled trials (RCTs) were included. Efficacy was determined by best-corrected visual acuity (BCVA) and central macular thickness (CMT). Safety was assessed based on the reports in the studies. Risk of bias was assessed using the Robins-I and Cochrane RoB 2.0 tools. RESULTS: Of 503 studies, 8 observational studies and 5 RCTs were included. In DME, RCTs showed a reduction in CMT (-105 μm; 95% CI: -129.8 to -80.3; I: 0%) and in BCVA a LogMAR reduction (-0.29; 95% CI: -0.36 to -0.21; I: 0%). Observational studies in DME showed a reduction in CMT (-108 μm; 95% CI: -133 to -83.1; I: 34%) and in BCVA a LogMAR reduction (-0.2; 95% CI: -0.26 a -0.14; I: 0%). In RVO, RCTs showed a reduction in CMT (-230 μm; 95% CI: -367 to -94; I: 46%). Observational studies in EMSOV showed a reduction in GMC (-160 μm; 95% CI: -257 to -64; I: 74%) and in BCVA (best corrected visual acuity) a reduction in LogMAR (-0.2; 95% CI: -0.26 to -0.14; I: 50%). No serious ocular or systemic adverse effects were reported. CONCLUSION: ZA-IV demonstrated efficacy and is potentially safe for the treatment of EMD and EMSOV.