Dexamethasone Implant as Adjunct Therapy for Wet AMD
Dexamethasone Implant as Adjunct Therapy for Wet AMD
Purpose To evaluate the visual and anatomical outcomes of dexamethasone intravitreal implant (DXI; 700 μg, Ozurdex; Allergan, Irvine, California, USA) as adjunctive therapy for patients with refractory wet age-related macular degeneration (AMD).
Methods Retrospective review of the medical records of seven patients (seven eyes) who initially responded well to intravitreal ranibizumab but subsequently developed persistent intra/sub-retinal fluid (IRF/SRF) and underwent a single injection of DXI, between May 2012 and May 2013. Two weeks after DXI, the patients continued with their monthly ranibizumab injections. Best corrected visual acuity (BCVA) logarithm of the minimum angle of resolution (logMAR) and central retinal thickness (CRT) were recorded at baseline, 2 weeks, 6 weeks, 3 months and 6 months after DXI injection. Complications were recorded too.
Results All patients had at least 24 months of ranibizumab treatment. Mean age was 81.5±5.8 years. At baseline, mean BCVA was 0.53±0.13 logMAR (20/70 Snellen) and mean CRT was 273.14±50.94 μm. BCVA did not change significantly after DXI over the follow-up period. However, all eyes had lost fewer than 0.3 logMAR units. Complete resolution of the persistent IRF/SRF was achieved in five eyes (71.4%) at 6 weeks, and remained stable at 3 months. Two weeks after DXI injection, the mean CRT diminished compared with baseline (248.28±31.8 μm; p=0.03) and the greatest reduction was observed at 3 months after DXI injection (241.5±36.6 μm; p=0.04). Progression of lens opacity was detected in one case (50% of phakic eyes). Retreatment with DXI was performed in two eyes.
Conclusions DXI appears to be effective in vision stabilisation, decreasing IRF/SRF and improvement of CRT in eyes with refractory wet AMD.
Since the introduction of anti-vascular endothelial growth factor (anti-VEGF) therapy for wet age-related macular degeneration (AMD), different treatment regimens have been developed. Multicentre studies such as MARINA and ANCHOR, have shown that monthly intravitreal injections of ranibizumab over a 2-year period not only maintained but improved best corrected visual acuity (BCVA), with a mean gain of 7.2 and 11.3 letters, respectively. However, there were still some patients with wet AMD (up to 10%) who had incomplete response with monthly ranibizumab treatment. Those patients lost >15 letters despite monthly ranibizumab injections. In these incomplete responders, steroidal anti-inflammatory drugs (triamcinolone, dexamethasone) are well known for their positive effects on AMD.
The complementary action of intravitreal steroid injection in neovascular AMD dates back to the combination of intravitreal triamcinolone acetonide and photodynamic therapy. Lately, a new sustained-release 700 μg dexamethasone intravitreal implant (DXI; Ozurdex; Allergan, Irvine, California, USA) has been approved for the treatment of patients with macular oedema following retinal vein occlusions (RVOs) or non-infectious uveitis.
The purpose of this study was to evaluate the visual and anatomic outcomes after adding DXI therapy to patients with wet AMD and persistent intra/sub-retinal fluid (IRF/SRF). To our knowledge, this is the first study to evaluate DXI as an adjunctive therapy for patients with refractory wet AMD.
Abstract and Introduction
Abstract
Purpose To evaluate the visual and anatomical outcomes of dexamethasone intravitreal implant (DXI; 700 μg, Ozurdex; Allergan, Irvine, California, USA) as adjunctive therapy for patients with refractory wet age-related macular degeneration (AMD).
Methods Retrospective review of the medical records of seven patients (seven eyes) who initially responded well to intravitreal ranibizumab but subsequently developed persistent intra/sub-retinal fluid (IRF/SRF) and underwent a single injection of DXI, between May 2012 and May 2013. Two weeks after DXI, the patients continued with their monthly ranibizumab injections. Best corrected visual acuity (BCVA) logarithm of the minimum angle of resolution (logMAR) and central retinal thickness (CRT) were recorded at baseline, 2 weeks, 6 weeks, 3 months and 6 months after DXI injection. Complications were recorded too.
Results All patients had at least 24 months of ranibizumab treatment. Mean age was 81.5±5.8 years. At baseline, mean BCVA was 0.53±0.13 logMAR (20/70 Snellen) and mean CRT was 273.14±50.94 μm. BCVA did not change significantly after DXI over the follow-up period. However, all eyes had lost fewer than 0.3 logMAR units. Complete resolution of the persistent IRF/SRF was achieved in five eyes (71.4%) at 6 weeks, and remained stable at 3 months. Two weeks after DXI injection, the mean CRT diminished compared with baseline (248.28±31.8 μm; p=0.03) and the greatest reduction was observed at 3 months after DXI injection (241.5±36.6 μm; p=0.04). Progression of lens opacity was detected in one case (50% of phakic eyes). Retreatment with DXI was performed in two eyes.
Conclusions DXI appears to be effective in vision stabilisation, decreasing IRF/SRF and improvement of CRT in eyes with refractory wet AMD.
Introduction
Since the introduction of anti-vascular endothelial growth factor (anti-VEGF) therapy for wet age-related macular degeneration (AMD), different treatment regimens have been developed. Multicentre studies such as MARINA and ANCHOR, have shown that monthly intravitreal injections of ranibizumab over a 2-year period not only maintained but improved best corrected visual acuity (BCVA), with a mean gain of 7.2 and 11.3 letters, respectively. However, there were still some patients with wet AMD (up to 10%) who had incomplete response with monthly ranibizumab treatment. Those patients lost >15 letters despite monthly ranibizumab injections. In these incomplete responders, steroidal anti-inflammatory drugs (triamcinolone, dexamethasone) are well known for their positive effects on AMD.
The complementary action of intravitreal steroid injection in neovascular AMD dates back to the combination of intravitreal triamcinolone acetonide and photodynamic therapy. Lately, a new sustained-release 700 μg dexamethasone intravitreal implant (DXI; Ozurdex; Allergan, Irvine, California, USA) has been approved for the treatment of patients with macular oedema following retinal vein occlusions (RVOs) or non-infectious uveitis.
The purpose of this study was to evaluate the visual and anatomic outcomes after adding DXI therapy to patients with wet AMD and persistent intra/sub-retinal fluid (IRF/SRF). To our knowledge, this is the first study to evaluate DXI as an adjunctive therapy for patients with refractory wet AMD.
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