– The article is a post hoc analysis of the PANORAMA phase 3 trial, which aimed to identify baseline systemic and ocular factors associated with worsening of nonproliferative diabetic retinopathy (NPDR) and the impact of intravitreal aflibercept injection (IAI) on these associations.

– Five baseline factors were identified as being associated with increased risk of NPDR worsening in sham-treated eyes: fluorescein leakage, retinal nonperfusion area, thicker central subfield thickness, eosinophil level, and proteinuria.

– The risk of developing vision-threatening complications (VTCs), center-involved diabetic macular edema (CI-DME), or ≥ ۲-step Diabetic Retinopathy Severity Scale (DRSS) worsening increased with increasing fluorescein leakage area and retinal nonperfusion area in the sham group.
– However, among IAI-treated eyes, increasing baseline fluorescein leakage or retinal nonperfusion areas did not increase the risks of NPDR worsening.
– This suggests that IAI treatment can mitigate the effect of these baseline risk factors and reduce the likelihood of NPDR worsening.
– The findings of this analysis can help identify patients at increased risk of disease progression and inform closer monitoring or earlier intervention strategies for these patients.

– The article concludes that increased areas of fluorescein leakage and retinal nonperfusion at baseline are key ocular biomarkers associated with NPDR worsening in sham-treated patients, but IAI treatment can mitigate this risk.