Background: Nonproliferative diabetic retinopathy [NPDR] is characterized by microvascular and intraretinal changes, including microaneurysms, hemorrhages, hard exudates, cotton wool spots, intraretinal micro-vascular abnormalities [IRMAs], and venous beadings.
The aim of the work: The Aim of this study is to evaluate the prognostic/predictive value of non-proliferative diabetic retinopathy phenotypes A, B and C in response to intravitreal Aflibercept injection for one year.
 Patients and Methods: An interventional multi-arm prospective cohort study was performed to compare responses of different non-proliferative diabetic retinopathy NPDR phenotypes to intravitreal injections.  Patients with mild to moderate NPDR were recruited and observed for 6 months, then allocated into three groups according to pattern of progression of diabetic retinopathy. Groups B and C received intravitreal injection on treat-and-extend basis. Results were collected and compared at the baseline visit, 6 months interval before receiving any treatment and 12 months from baseline visit [months after receiving the first dose].
Results: Comparing the ETDRS severity level according to the ETDRS severity scale, between the three groups shows statistically significant differences at all points of comparison. Concerning microaneurysms turnover. Groups B and C shows statistically significant changes among all visit concerning central foveal thickness, Group A shows no change in the mean central foveal thicknesses, while group B and C show statistically significant increase during the first 6 months of the study, and statistically significant decrease during the second 6 months of the study.
Conclusion: Anti-VEGF injection in NPDR without macular edema, is found useful in improving the DRSS and delaying or preventing the development of PDR. These results agree with data published by the PANORAMA clinical study.