Dexamethasone Implant and Anti-VEGF Therapy Effective for NAMD


Combining the dexamethasone implant with anti-VEGF treatment can restore foveal anatomy in eyes resistant to anti-VEGF injection.

Findings of a recent study demonstrate dexamethasone implant and anti-vascular endothelial growth factor (VEGF) treatment may be useful in eyes resistant to monotherapy.

The findings of the research presented were at the American Society of Retina Specialists (ASRS 2020) Virtual Sessions.

Raja Narayanan, MD, MBA, and a team of investigators evaluated the efficacy of combination dexamethasone implant and anti-VEGF therapy in eyes resistant to anti-VEGF monotherapy in age-related macular degeneration in an Asian population. A retrospective study was conducted among 16 patients (17 eyes) who were resistant to anti-VEGF injections. Cases were resistant if they had less than 10% reduction in macular thickness on optical coherence tomography.

Narayanan and the team included patients with neovascular age-related macular degeneration with subfoveal choroidal neovascular membranes who had a minimum of 3 consecutive monthly anti-VEGF injections in the previous 12 weeks.

Patients were injected with a dexamethasone implant and an anti-VEGF agent. The team analyzed best-corrected visual acuity, slit lamp examination, intraocular pressure, fundus evaluation, and optical coherence tomography. The injection-free interval after the dexamethasone implant was also analyzed by the investigators.

The patients were evaluated again after 1 month. Those who had the presence of any macular fluid were reinjected with anti-VEGF therapy.

The primary outcome measure was anatomical response on optical coherence tomography. Secondary outcomes included gain in visual acuity and injection-free interval after the dexamethasone implant.

Of the patients included, the mean age was 69.3 years old and there were more females (56.25%) than males. There were 12 eyes with polypoidal choroidal vasculopathy and 5 had neovascular age-related macular degeneration. The mean prior number of anti-VEGF injections was 4.5 and mean follow-up after dexamethasone implant was 11.2 months.

Narayanan reported a significant reduction in macular edema as seen on optical coherence tomography. The mean thickness reduced from 612.05 microns to 306.81 microns at the last visit, which was statistically significant (P=.001).

The visual acuity was not statistically significant from baseline at 1 month and last follow-up. The mean injection-free interval in patients after the dexamethasone implant was 169.8 days, which was significantly greater than the pre-injection mean of 35.2 days (P <.001).

Overall, combining the dexamethasone implant with anti-VEGF treatment can restore foveal anatomy in eyes resistant to anti-VEGF injection, all while maintaining visual acuity in neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. The burden of frequent injections could be reduced with the addition of such an implant, Narayanan and the study investigators concluded.

The study, “Combination of Dexamethasone Implant and Anti-VEGF Therapy in Neovascular Age-Related Macular Degeneration,” was presented at ASRS 2020.

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