Abstract
A significant proportion of eyes with polypoidal choroidal vasculopathy (PCV) can be resistant to anti-vascular endothelial growth factor (VEGF) injections. We evaluated the efficacy of a combination of dexamethasone intravitreal implant (DXI) and anti-VEGF therapy in eyes resistant to anti-VEGF monotherapy. In this retrospective study, patients with PCV resistant to anti-VEGF injections were additionally injected with a DXI along with an anti-VEGF agent. Best-corrected visual acuity (BCVA), slit-lamp examination, fundus evaluation, and optical coherence tomography (OCT) data were analyzed. Anatomical response on OCT was the primary outcome measure. Change in visual acuity and injection-free interval after DXI were evaluated as secondary outcome measures. Twelve eyes of 11 patients were included in the study. Mean age of patients at presentation was 64.7 ± 9.5years (range, 49-78.8years), and there were seven females (63.6%). Median number of anti-VEGF injections prior to DXI was 4 (interquartile range IQR, 3-7). Median follow-up duration after DXI was 32.2months (IQR, 6.6-41.6months). Median logMAR BCVA immediately prior to DXI was 0.41 (IQR, 0.30-0.88) and after injection was0.40 (IQR, 0.30-1.05), which was not significantly different (p = 0.85). Median Central Retinal Thickness (CRT) after DXI was 305.5µm (IQR, 249-409µm), which was significantly (p = 0.003) lesser than pre-injection thickness of 547µm (IQR, 431-771µm). Median injection-free interval in these eyes after DXI was 5months (IQR, 2.8-6.4months). Kaplan-Meier estimates of first injection after DXI were 27.3% at 3months, 67.3% at 6months, and 89.1% at 12months. Dexamethasone implant combined with anti-VEGF treatment can prolong the treatment-free interval in eyes with PCV resistant to anti-VEGF injection while maintaining visual acuity.
Highlights
The mean injection-free interval in these patients after Dexamethasone intravitreal implant (DXI) was 4.7± 0.6 months, which was significantly greater than the pre-injection mean of 1.6 ± 0.4 months (p
The median optical coherence tomography (OCT) thickness after DXI in was 305 microns (IQR 206-417), which was significantly less than the pre-injection OCT thickness of 547 microns (IQR 432-685) (p=0.005)
Dexamethasone implant combined with anti-vascular endothelial growth factor (VEGF) treatment can prolong the treatment-free interval in eyes with polypoidal choroidal vasculopathy (PCV) resistant to anti-VEGF injection, while maintaining visual acuity
Summary
Intravitreal injection of anti-vascular endothelial growth factor (VEGF) is the standard of care for choroidal neovascular membrane (CNVM) due to neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV).[1,2,3,4] a significant portion of eyes treated with antiVEGF show little or no response to the therapy.[5,6] Estimates of the prevalence of this anti-VEGF resistance among eyes with CNVM vary significantly in the literature based on anti-VEGF drug of choice, specific sub-type diagnosis such as nAMD or PCV, treatment style (prn vs treat-and-extend vs monthly regimen) and the ethnic population.[6,7,8,9]Various inflammatory cytokines, such as macrophage derived chemokine (MDC), interleukins, and monocyte chemotactic protein levels were significantly higher in PCV patients have been shown to be elevated in eyes with PCV.[10]. Intravitreal injection of anti-vascular endothelial growth factor (VEGF) is the standard of care for choroidal neovascular membrane (CNVM) due to neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV).[1,2,3,4] a significant portion of eyes treated with antiVEGF show little or no response to the therapy.[5,6] Estimates of the prevalence of this anti-VEGF resistance among eyes with CNVM vary significantly in the literature based on anti-VEGF drug of choice, specific sub-type diagnosis such as nAMD or PCV, treatment style (prn vs treat-and-extend vs monthly regimen) and the ethnic population.[6,7,8,9]. We evaluated the efficacy of combination of Dexamethasone intravitreal implant (DXI) and anti-VEGF therapy in eyes resistant to antiVEGF monotherapy
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