June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Simultaneous combination steroid anti-VEGF therapy for monotherapy resistant macular disease
Author Affiliations & Notes
  • Alexandra Warter
    Opthalmology, University of California San Diego, La Jolla, California, United States
  • Melina Cavichini Cordeiro
    Opthalmology, University of California San Diego, La Jolla, California, United States
  • Dirk-Uwe G Bartsch
    Opthalmology, University of California San Diego, La Jolla, California, United States
  • Sumit R Singh
    Opthalmology, University of California San Diego, La Jolla, California, United States
  • Dr. William R Freeman
    Opthalmology, University of California San Diego, La Jolla, California, United States
  • Footnotes
    Commercial Relationships   Alexandra Warter, None; Melina Cavichini Cordeiro, None; Dirk-Uwe Bartsch, None; Sumit Singh, None; Dr. William Freeman, None
  • Footnotes
    Support  UCSD Vision Research Center Core Grant P30EY022589, NIH grant R01EY016323, Unrestricted grant from Research to Prevent Blindness, NY
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 2207. doi:
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    • Get Citation

      Alexandra Warter, Melina Cavichini Cordeiro, Dirk-Uwe G Bartsch, Sumit R Singh, Dr. William R Freeman; Simultaneous combination steroid anti-VEGF therapy for monotherapy resistant macular disease. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2207.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Our purpose was to analyze the safety and efficacy of the use of combined anti-VEGF and long-acting steroid IV therapeutic agents in resistant macular fluid after conventional monotherapy. We performed a retrospective observational clinical study to assess anatomical and visual changes in a consecutive cohort of patients resistant to aggressive monotherapy in retinovascular (RVD) induced edema (ME) and choroidal vascular induced edema (CNV) in Wet-AMD.

Methods : This study included a total of 28 eyes (56 injections) with nonresponsive macular fluid after a standardized protocol consisting in escalation treatment with varied doses of alternating anti-VEGF or steroid injections. Resistance was defined as persistent fluid after escalation of anti-VEGF to 1mg Aflibercept every 4 weeks and additional monotherapy resistance to IV Triamcinolone Acetonide (TCA) or Dexamethasone in RVD. A prior mean of injections was 36.45[18-67] in Wet-AMD and 9.17[3-17] in RVD. Combination therapy consisted in the simultaneous administration of IV anti-VEGF and steroid. Slit lamp evaluation, VA, IOP, and Optical Coherence Tomography (Heidelberg Spectralis) measurements of central retinal thickness (CRT) were recorded every 4 weeks post injection. All eyes received prophylactic topical anti-glaucoma medication for 2 weeks (Timolol 0.5%/Dorzolamide 2%). Outcomes included reduction in CRT, VA, and IOP changes.

Results : Our initial analysis was performed post first injection of combined therapy in one eye of each patient. Safety data showed no evidence of infection. 14% of patients reported transient visual obscuration due to TCA particles. There was a modest rise in IOP in 19% of patients; no eyes required glaucoma surgery or showed vascular occlusions. Anatomic outcomes showed a statistically significant reduction in CRT in both groups; paired analysis showed an average CRT reduction of 45.55μm±SD20.656 (p<0.05) in CNV and 145μm±SD31.651(p<0.0003) in RVD. There was a non-significant trend of VA improvement (p=0.712).

Conclusions : We found that combination of IV steroids and anti-VEGF produces clear anatomic improvement in CNV. Other studies have evaluated combination therapy in RVD and found vision improvement, but not in eyes resistant to monotherapy with both anti-VEGF and steroids. In such eyes, we found overall disease improvement. Combination therapy therefore may be useful in treating resistant Wet-AMD CNV and RVD ME.

This is a 2021 ARVO Annual Meeting abstract.

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