Research limited on role of combination therapy for CRVO-related ME
More data are needed to determine the use of combination therapy for treatment of macular edema (ME) secondary to central retinal vein occlusion (CRVO) and to identify whether there is an ideal strategy. For now, however, combination therapy may be a reasonable approach to manage eyes that are not responding to intravitreal monotherapy with an anti-vascular endothelial growth factor (VEGF) agent or corticosteroid, said Lihteh Wu, MD, at the inaugural Retina World Congress.
“Intravitreal treatment with a corticosteroid or anti-VEGF agent alone is currently the first-line treatment for ME secondary to CRVO, and there is no evidence to support the use of combination therapy as primary intervention,” said Dr. Wu, consulting surgeon, Asociados de Macula, Vitreo y Retina de Costa Rica, San José, Costa Rica.
“There have also been very few studies investigating combination therapy for management of refractory or recurrent ME therapy, and those that have been published are small and short-term, include retrospective reviews, and have generated inconsistent results," Dr. Wu said. "Based on theory and limited clinical data, however, combination therapy with an anti-VEGF agent corticosteroid or laser therapy should be considered in eyes that do not respond to intravitreal monotherapy.”
Interest in the role of combination therapy as initial or second-line intervention for ME secondary to CRVO arises from data showing that a sizeable proportion of eyes do not respond to monotherapy despite receiving multiple continuous injections.
Citing results from large-scale, randomized studies investigating intravitreal anti-VEGF agents and intravitreal triamcinolone, Dr. Wu noted that up to 25% of eyes suffered a best-corrected visual acuity (BCVA) loss of ≥15 letters and up to 52% had residual ME.