{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T09:23:34Z","timestamp":1788341014700,"version":"build-2803163510"},"reference-count":33,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Purpose: To evaluate the incidence, predictors, and clinical impact of treatment-emergent epiretinal membrane (ERM) in diabetic macular edema (DME) treated with dexamethasone implant, aflibercept, ranibizumab, bevacizumab, or faricimab. Methods: In this multicenter, retrospective, nonrandomized study, 501 eyes with center-involving DME were assessed and 423 eyes without ERM on pretreatment OCT and with 24-month follow-up were included. Eyes were classified by the intravitreal agent selected by the treating physician in routine care and maintained throughout follow-up; eyes requiring a drug switch or retinal laser\/vitrectomy during follow-up were excluded. The last eligible pre-index SD-OCT confirmed the absence of ERM; BCVA, central subfield thickness (CST), and vitreomacular-interface (VMI) morphology were assessed at baseline and 6, 12, 18, and 24 months. Crude comparisons, multivariable logistic regression, and Kaplan\u2013Meier\/log-rank analyses were performed. Results: ERM developed in 36\/423 eyes (8.5%). Incidence was 16.0% with dexamethasone implant, 7.5% with aflibercept, 7.7% with ranibizumab, 7.4% with bevacizumab, and 4.3% with faricimab. Dexamethasone implant showed higher ERM odds than pooled non-dexamethasone therapy after adjustment (OR 2.24, 95% CI 1.02\u20134.92; p = 0.044). Baseline VMI abnormality, severe NPDR\/PDR, prior PRP, and higher baseline CST were also associated with ERM. Eyes developing ERM had smaller BCVA gains (+2.8 vs. +7.1 ETDRS letters; p &lt; 0.001) and CST reductions (88.6 vs. 130.8 \u00b5m; p = 0.004). Conclusions: Treatment-emergent ERM was associated with baseline ocular characteristics and treatment category and with poorer 24-month outcomes. These observational drug-group signals require prospective confirmation.<\/jats:p>","DOI":"10.3390\/ph19091390","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T08:56:01Z","timestamp":1788339361000},"page":"1390","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment-Emergent Epiretinal Membrane in Diabetic Macular Edema: A Real-World OCT-Based Comparative Pharmacotherapy Study Across Intravitreal Agents\u2014The TRIDENT-DME Study"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9693-7882","authenticated-orcid":false,"given":"Debdulal","family":"Chakraborty","sequence":"first","affiliation":[{"name":"Disha Eye Hospitals, Barrackpore, Kolkata 700120, West Bengal, 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Kanti","family":"Biswas","sequence":"additional","affiliation":[{"name":"Nethralayam Superspeciality Eye Hospital, Kolkata 700099, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"given":"Aniruddha","family":"Maiti","sequence":"additional","affiliation":[{"name":"Global Eye Hospitals Kolkata, Kolkata 700106, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"given":"Manab Jyoti","family":"Barman","sequence":"additional","affiliation":[{"name":"ASG Eye Hospitals, Guwahati 781001, Assam, India"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Ranabir","family":"Bhattacharya","sequence":"additional","affiliation":[{"name":"Disha Eye Hospitals, Barrackpore, Kolkata 700120, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Subhendu Kumar","family":"Boral","sequence":"additional","affiliation":[{"name":"Disha Eye Hospitals, Barrackpore, Kolkata 700120, West Bengal, 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