Background: This study aimed to assess efficacy differences of aflibercept by intravitreal injection for diabetic macular edema (DME) with different OCT types. Methods: according to OCT morphology, 128 patients (128 eyes) with DME were divided into the diffuse retinal thickening (DRT; 41 patients, 41 eyes), cystoid macular edema (CME; 47 patients, 47 eyes), and serous retinal detachment (SRD; 40 patients, 40eyes) groups. All patients were treated by intravitreal injection of 0.5 mg (0.05 mL) aflibercept according to the 3+prn regimen. BCVA (LogMAR) and central foveal thickness (CFT) among the three groups at baseline, and 1 month, 3 months, 6 months and 12 months after treatment, respectively, were assessed. Results: At 1 month, 3 months, 6 months and 12 months after treatment, improvements in BCVA and CFT in the three groups showed statistical significance (P<0.05). BCVA improvement was better at all time points in the DRT group compared with the SRD group (P<0.05). BCVA improvement was also better in the CME group compared with the SRD group at 6 months and 12 months post-treatment (P<0.05). At 1 month, 3 months and 6 months after treatment, CFT differences among the three groups had no statistical significance (P>0.05), while at 12 months post-treatment, CFT values among the three groups had significant differences (F=3.77, P=0.0269). at 12 months after treatment, CFT improvement was better in the DRT and CME groups compared with the SRD group (P<0.05). Conclusion: aflibercept by intravitreal injection could significantly improve visual acuity in DME patients with different OCT types and reduce CFT. At the initial treatment of 12 months, CFT and BCVA improvements in the DRT and CME types were the most pronounced.