{ "abstract": "Purpose: To longitudinally quantify changes in retinal vascular leakage in diabetic macular edema (DME) using ultra-widefield fluorescein angiography (UWF-FA) in patients receiving brolucizumab versus aflibercept.\n\nDesign: Retrospective post hoc analysis of the phase 3, randomized, masked KINGFISHER clinical trial.\n\nSubjects: Eyes with center-involved DME enrolled in KINGFISHER with gradable late-phase UWF-FA images at baseline and follow-up (week 24 and/or week 52).\n\nMethods: Two independent masked graders manually assessed late-phase UWF-FA images at baseline, week 24, and week 52 using OptosAdvance software. The leakage area, defined as regions of increased fluorescence relative to background, was manually segmented and quantified in 3 regions: the posterior pole zone (defined as the central 15-mm ring), the peripheral zone (all analyzable areas outside the posterior pole), and the total retina. The leakage index (LI) was then calculated as the ratio of the total leakage area to the total area of the corresponding region and expressed as a percentage.\n\nMain Outcome Measures: Change in LI from baseline to week 24 and week 52 in the posterior pole, peripheral zone, and total analyzable retina, and between-treatment differences in LI change.\n\nResults: A total of 106 cases were included (69 in the brolucizumab arm and 37 in the aflibercept arm). Both treatments significantly reduced LI from baseline to week 24 and from baseline to week 52 (P < 0.001). By week 24, the brolucizumab group demonstrated a statistically significantly greater reduction in the posterior pole LI compared to the aflibercept group (mean change, –24.7 ± 21.3 vs. –16.8 ± 12.4; P = 0.037). However, by week 52, there were no statistically significant differences between the 2 arms in any retinal region (P > 0.2).\n\nConclusions: Both brolucizumab and aflibercept substantially reduced UWF-FA leakage in DME over 52 weeks. Brolucizumab achieved a more pronounced early reduction in leakage within the posterior pole, although the final residual leakage at week 52 was comparable between the 2 agents.\n\nFinancial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.", "abstract_shown": true, "affiliations": [ "Doheny Eye Institute, Pasadena, California.", "Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California.", "Ophthalmology Department, Tanta University, Tanta, Egypt.", "Department of Neurosciences, Imaging and Clinical Sciences, University \"G. d'Annunzio\" Chieti-Pescara, Chieti, Italy.", "Department of Ophthalmology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.", "Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical, Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China.", "Department of Artificial Intelligence, Tamkang University, New Taipei City, Taiwan.", "Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan.", "Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China." ], "article_type": "research article", "arxiv": null, "author_total": 16, "authors": [ { "affs": [ 0, 1 ], "name": "Rouzbeh Abbasgholizadeh" }, { "affs": [ 0, 1, 2 ], "name": "Mai Alhelaly", "orcid": "0000-0003-0574-1660" }, { "affs": [ 0, 1 ], "name": "Abbas Habibi" }, { "affs": [ 0, 1 ], "name": "Ceren Soylu" }, { "affs": [ 0, 1, 3 ], "name": "Alberto Quarta" }, { "affs": [ 0, 1, 4 ], "name": "Yu-Chien Chung" }, { "affs": [ 0, 1, 5 ], "name": "Ye He" }, { "affs": [ 6 ], "name": "Yen-Chun Huang" }, { "affs": [ 2 ], "name": "Magdy Moussa" }, { "affs": [ 2 ], "name": "Mohamed El-Bradey" }, { "affs": [ 2 ], "name": "Mamdouh Kabil" }, { "affs": [ 0, 1, 7 ], "name": "Shinichiro Chujo" }, { "affs": [ 0, 1, 8 ], "name": "Jianfeng Huang" }, { "affs": [ 0 ], "name": "Muneeswar G Nittala" }, { "affs": [ 0, 1 ], "name": "Srinivas R Sadda" }, { "affs": [ 0, 1 ], "name": "Michael S Ip" } ], "bibtex": "https://research.draconitic.com/paper/f30h3y2rr50xp.bib", "cited_by": 0, "doi": "10.1016/j.xops.2026.101376", "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13696360/", "id": "f30h3y2rr50xp", "issns": [ "2666-9145" ], "landing_url": "https://doi.org/10.1016/j.xops.2026.101376", "language": "en", "licence": "CC-BY-NC-ND-4.0", "licence_label": "CC BY-NC-ND 4.0", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Original Article" ], [ "openalex", "2731|Retinal Diseases and Treatments" ] ], "openalex": "W7203771533", "pdf_url": "https://europepmc.org/articles/PMC13696360?pdf=render", "pmcid": "PMC13696360", "pmid": "42935789", "published": "2026-08-19", "publisher": "Elsevier", "ris": "https://research.draconitic.com/paper/f30h3y2rr50xp.ris", "sources": [ { "first_seen": "2026-10-30T12:17:43Z", "native_id": "PMC13696360", "source": "pmc", "url": "https://doi.org/10.1016/j.xops.2026.101376" }, { "first_seen": "2026-10-30T12:22:24Z", "native_id": "MED:42935789", "source": "europepmc", "url": "https://europepmc.org/article/MED/42935789" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2731|Retinal Diseases and Treatments", "subfield": "general" } ], "title": "Longitudinal Quantitative Analysis of Ultra-Widefield Fluorescein Angiography Leakage Metrics: Analysis of the KINGFISHER Clinical Trial", "title_text": "Longitudinal Quantitative Analysis of Ultra-Widefield Fluorescein Angiography Leakage Metrics: Analysis of the KINGFISHER Clinical Trial", "type": "peer-reviewed", "updated_at": "2026-10-30T12:33:42Z", "url": "https://research.draconitic.com/paper/f30h3y2rr50xp", "venue": "Ophthalmology Science", "versions": [] }