INTRAVITREAL DEXAMETHASONE IMPLANT AS ADJUVANT TREATMENT for BEVACIZUMAB- and RANIBIZUMAB-RESISTANT NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: A Prospective Pilot Study
Loading...
Date
Journal Title
Journal ISSN
Volume Title
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose: To study the benefit of intravitreal dexamethasone implant in the management of neovascular age-related macular degeneration resistant to bevacizumab and ranibizumab. Methods: Patients with persistent macular fluid on optical coherence tomography despite monthly treatment with at least three consecutive bevacizumab injections followed by at least three ranibizumab injections were prospectively enrolled. A single dexamethasone implant was administered followed by intravitreal ranibizumab 1 week later. Ranibizumab was continued afterward on an as-needed basis. Main outcomes were improvement in central retinal thickness and best-corrected visual acuity. Results: Nineteen patients (19 eyes) were enrolled. There was no significant change in best-corrected visual acuity over 6 months. Greatest reduction in mean central retinal thickness, from 295.2 m to 236.2 m, occurred 1 month after dexamethasone implant (P < 0.0001). By Month 6, mean central retinal thickness was 287.3 m (P = 0.16). Eyes with only intraretinal fluid (13 eyes) achieved a fluid-free macula. Eyes with predominantly subretinal fluid (6 eyes) did not improve central retinal thickness and continued monthly ranibizumab. Mean baseline intraocular pressure was 13.2 mmHg, which peaked at 15.6 mmHg by Month 2 (P = 0.004). Conclusion: Intravitreal dexamethasone implant improved only macular intraretinal fluid in eyes with neovascular age-related macular degeneration resistant to bevacizumab and ranibizumab. However, this treatment had a limited duration.
Description
Keywords
Age-related macular degeneration, Anti-vegf, Choroidal neovascularization, Corticosteroids, Dexamethasone implant, Aged, 80 and over, Bevacizumab, Dexamethasone, Dose-response relationship, drug, Drug implants, Drug resistance, Drug therapy, combination, Female, Follow-up studies, Glucocorticoids, Humans, Intravitreal injections, Male, Pilot projects, Prospective studies, Ranibizumab, Time factors, Tomography, optical coherence, Treatment outcome, Visual acuity, Wet macular degeneration, Glucocorticoid, Adjuvant therapy, Aged, Antiangiogenic therapy, Article, Best corrected visual acuity, Central retinal thickness, Chronopharmacology, Clinical article, Clinical evaluation, Clinical outcome, Clinical trial, Corticosteroid therapy, Drug efficacy, Drug implant, Drug safety, Drug substitution, Drug withdrawal, Follow up, Human, Intraocular pressure, Intraocular pressure abnormality, Intraretinal fluid, Intravitreal implant, Off label drug use, Optical coherence tomography, Pilot study, Prospective study, Pseudophakia, Retina edema, Retina macula lutea, Retreatment, Single drug dose, Subretinal fluid, Subretinal neovascularization, Sustained drug release, Treatment duration, Treatment response, Very elderly, Combination drug therapy, Dose response, Intravitreal drug administration, Pathophysiology, Procedures, Time factor