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    Role of corticosteroids uncertain in AMD management

     

    Dexamethasone study

    Another study [Chaudhary V, et al. Can J Ophthalmol. 2016;51(4):302-305]

    evaluated the dexamethasone implant (Ozurdex, Allergan) in a small study that included 10 patients treated with anti-VEGF injections alone or combined with the sustained-release corticosteroid.

    “Dexamethasone phosphate may have a very limited effect because it is present in the eye for only 4 to 5 days,” Dr. de Smet said. “Even so, in this study using the implant that has a longer duration of action, there was still no difference in functional or anatomic outcomes at 1 year.”

    Dr. de Smet pointed out that the authors, however, reported the corticosteroid may have provided a benefit considering that the patients receiving the dexamethasone implant were on average 10 years older than the anti-VEGF group.

    Another study [Forte R, et al Ophthalmic Res. 2011;45(3):129-134] looked at triple therapy combining anti-VEGF injection with full fluence PDT and dexamethasone compared with anti-VEGF monotherapy. Patients included in this retrospective investigation were treatment-naïve and after an initial treatment with the monotherapy or triple therapy were followed every 1 to 2 months for signs of disease activity to guide retreatment.

    Both groups had improvement in foveal thickness and visual acuity during an average follow-up of 14 and 16 months, respectively. Although there was no real difference between groups with regards to those outcomes, time to first retreatment was longer in the triple therapy group than in the eyes receiving anti-VEGF therapy alone (5.4 vs. 3.6 months).

    Calvo and colleagues [Calvo P, et al. Br J Ophthalmol. 2015;96(6):723-726] investigated the dexamethasone implant in patients whose neovascular AMD responded incompletely to ranibizumab. The 7 patients included in this series had been treated for at least 24 months with ranibizumab and initially responded well, but then developed persistent intra/subretinal fluid.

    The analyses of their outcomes showed stabilization of vision along with decrease in the intra/subretinal fluid and reduced central retinal thickness. “Other case control studies show similar results,” Dr. de Smet added.

    Targeting vascular leakage

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