Comparative Study of Dexamethasone Implant to Intravitreal Aflibercept in Subjects With Diabetic Macular Edema

Prior treatment

• Any prior or concomitant therapy with another investigational agent to treat DME in the study eye.
• Prior panretinal photocoagulation in the study eye.
• Prior intravitreal anti-VEGF therapy in the study eye.
• Prior focal/grid laser photocoagulation in the study eye.
• Prior history of intravitreal steroid therapy in the study eye.
• Uncontrolled glaucoma at baseline evaluation (defined as intraocular pressure ≥25 mmHg despite treatment with anti-glaucoma medication) in the study eye and/or cup-to-disc ratio greater or equal to 0.8.
• Prior systemic anti-VEGF therapy, investigational or FDA-approved, is only allowed up to 3 months prior to first dose, and will not be allowed during the study.
• Prior vitrectomy in the study eye.
• Any intraocular or periocular surgery within 3 months of Day 1 in the study eye, except lid surgery, which may not have taken place within 1 month of day 1, as long as it's unlikely to interfere with the injection.
• Prior trabeculectomy or other filtration surgery in the study eye.
• Any ocular or periocular infection within the last 2 weeks prior to Screening in either eye.
• Previous therapeutic radiation in the region of the study eye.
• Any concurrent intraocular condition in the study eye (e.g. cataract) that, in the opinion of the investigator, could require either medical or surgical intervention during the study period.
• Any concurrent ocular condition in the study eye which, in the opinion of the investigator, could either increase the risk to the subject beyond what is to be expected from standard procedures of intraocular injection, or which otherwise may interfere with the injection procedure or with evaluation of efficacy or safety.
• Participation as a subject in any clinical study within the 12 weeks prior to Day 1.
• Any systemic therapy with an investigational agent in the past 3 months prior to Day 1.
• Women of childbearing potential\* who are unwilling to practice adequate contraception during the study (adequate contraceptive measures include stable use of oral contraceptives or other prescription pharmaceutical contraceptives for 2 or more menstrual cycles prior to screening; intrauterine device \[IUD\]; bilateral tubal ligation; vasectomy; condom plus contraceptive sponge, foam, or jelly, or diaphragm plus contraceptive sponge, foam, or jelly) \*Postmenopausal women must be amenorrheic for at least 12 months in order not to be considered of child bearing potential. Pregnancy testing and contraception are not required for women with documented hysterectomy or tubal ligation.

Other illness

• Active ocular or periocular infection in either eye.
• Significant vitreous hemorrhage obscuring view to the macula or the retinal periphery as determined by the investigator on clinical exam and ultra-widefield angiography, in study eye.
• History of retinal detachment or treatment or surgery for retinal detachment in the study eye.
• Any history of macular hole of stage 2 and above in the study eye.
• Any history of uveitis in either eye.
• Presence or history of scleromalacia in either eye.
• History of corneal transplant or corneal dystrophy in the study eye.
• Any history of allergy to povidone iodine.

Lab values

• Any history of severe allergy to fluorescein sodium (e.g., anaphylaxis, difficulty breathing) or other reason that the patient is unable to undergo fluorescein angiography (e.g., inability to get vascular access, unable to tolerate procedure). If allergy is mild and investigator believes can be pretreated with diphenhydramine to avoid allergic response, this is not an exclusion to enrollment.

Age

• Presence of other causes of macular edema, including pathologic myopia (spherical equivalent of -8 diopters or more negative, or axial length of 25 mm or more), ocular histoplasmosis syndrome, angioid streaks, choroidal rupture, choroidal neovascularization, age-related macular degeneration or multifocal choroiditis in the study eye. Epiretinal membranes are allowed.

Other

• Active intraocular inflammation in either eye.
• Torn or ruptured posterior lens capsule in study eye. Laser capsulotomy is not a contraindication.
• Presence of macula-threatening traction retinal detachment in the study eye.
• Active scleritis or episcleritis in either eye.
• Aphakia in the study eye.
• Significant media opacities, including cataract, in the study eye which might interfere with visual acuity, assessment of safety, or fundus photography.
• Pregnant or breast-feeding women

• Signed Informed Consent.
• Men and women ≥ 18 years of age.
• Foveal-involving retinal edema secondary to DME based on investigator review of SD-OCT.
• Central subfield thickness on SDOCT of greater than or equal to 325 microns on Spectralis or 300 microns on Cirrus.
• E-ETDRS best-corrected visual acuity of 20/400 or better in the study eye.
• Willing, committed, and able to return for ALL clinic visits and complete all study related procedures.
• Able to read, (or, if unable to read due to visual impairment, be read to verbatim by the person administering the informed consent or a family member) understand and willing to sign the informed consent form.