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    Role of corticosteroids uncertain in AMD management

    There is no doubt that inflammation is a component of age-related macular degeneration (AMD), and yet the role of corticosteroid treatment in the management of eyes with AMD remains uncertain, said Marc de Smet, MD, PhD.

    “Intravitreal corticosteroid treatment may be useful in eyes that have frequent recurrences while receiving anti-VEGF injections or that seem to have an insufficient response,” said Dr. de Smet, director, MIOS (Microinvasive Ocular Surgery), Lausanne, Switzerland. “In these cases, the corticosteroid can provide benefit by reducing the level of immune activation and reduce tachyphylaxis for example by the generation of neutralizing antibodies.”

    Dr. de Smet said that in these cases, it is better to use a sustained-release product rather than a soluble formulation. “It may be also better to combine the corticosteroid with other modalities, such as verteporfin (Visudyne, Bausch + Lomb) photodynamic therapy (PDT),” he added. “In addition, corticosteroids may be more useful for reducing vascular leakage rather than for treating active neovascularization.”

    Click here to expand image.

    Click here to expand image.

    Dr. de Smet’s comments about corticosteroids in the management of AMD were based on a review of the literature. He cited a study published in 2013 that randomized 37 patients to treatment with intravitreal (soluble) dexamethasone phosphate, combined with ranibizumab (Lucentis, Genentech) or the anti-VEGF agent alone [Ranchod TM, et al. Retina. 2013;33(8):1600-1604].

    All patients received 4 monthly injections and then as needed according to findings during follow-up. At 1 year, there was no difference between study groups in either visual acuity or central macular thickness outcomes.

    Dexamethasone study


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