Simultaneous Intravitreal Steroid and Anti-VEGF Therapy for Monotherapy-Resistant Chronic Wet Age-Related Macular Degeneration.

Abstract

Background and objective: The purpose of this study was to analyze the safety and efficacy of combined intravitreal anti-vascular endothelial growth factor (anti-VEGF) and steroid therapeutic agents for resistant choroidal neovascularization (CNV). A retrospective observational clinical study was performed assessing anatomic and visual changes in a consecutive cohort of patients with refractory chronic wet age-related macular degeneration resistant to high-dose aflibercept therapy.

Patients and methods: Twelve eyes of 12 patients with unresponsive CNV despite aggressive monthly anti-VEGF (4-mg aflibercept [mean: 43.75 ± SD23.08]) were included. Combination consisted of simultaneous administration of anti-VEGF and corticosteroids. Study measures evaluated visual acuity, central retinal thickness (CRT), and intraocular pressure.

Results: Paired tests revealed significant CRT reduction from the baseline at the 1-month (388.58 ± 89.31 versus 334.00 ± 92.88, P = 0.0117), 2-month (388.58 ± 89.31 versus 312.08 ± 75.61, P = 0.0185), and 3-month (388.53 ± 89.31 versus 304.56 ± 53.28, P = 0.046) visit. The Kaplan-Meier curve showed a median time of remission (no retinal fluid) of 70 days (95% CI 53, 147 days).

Conclusion: Combination treatment demonstrated clear anatomic improvement in eyes with anti-VEGF-resistant CNV. [Ophthalmic Surg Lasers Imaging Retina 2024;55:698-704.].