Simultaneous intravitreal dexamethasone and aflibercept for refractory macular edema secondary to retinal vein occlusion
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MEDICAL OPHTHALMOLOGY
Simultaneous intravitreal dexamethasone and aflibercept for refractory macular edema secondary to retinal vein occlusion Chiara Giuffrè 1 & Maria Vittoria Cicinelli 1 Francesco Bandello 1
&
Alessandro Marchese 1 & Michele Coppola 2 & Maurizio Battaglia Parodi 1 &
Received: 28 August 2019 / Revised: 11 December 2019 / Accepted: 18 December 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To assess the functional and anatomical outcomes of concurrent administration of aflibercept injection and dexamethasone (DEX) implant in patients with macular edema (ME) secondary to retinal vein occlusion (RVO), refractory to each of the two drugs previously administered as monotherapy. Secondary outcomes included the number of retreatments required in a 12month follow-up and safety. Methods This is a prospective, interventional case series of consecutive patients with refractory ME secondary to RVO, followed over a year. One injection of aflibercept was followed by a DEX implant on the same day; retreatment was driven by the persistence of ME on SD-OCT at least 4 months after the previous combined therapy. Central retinal thickness (CRT), best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were collected at 1 month and then every 2 months until the end of follow-up. Results Thirty eyes of 30 Caucasian patients were enrolled; mean duration of RVO before the first combined treatment was 25 ± 5 months (range 11 ± 30). Baseline BCVA was 0.73 ± 0.5 LogMAR, with no significant changes at 12 months (0.77 ± 0.51 μm, p = 0.2). Baseline CRT was 578.3 ± 161 μm, reducing to 352.5 ± 81 μm at 12 months (p = 0.003). Thirteen eyes (43.3%) required a second treatment. Twenty eyes (66.6%) showed no ME at the end of follow-up. One patient (3.3%) required topical IOPlowering therapy during the study. Conclusion In eyes with ME secondary to RVO unresponsive to either aflibercept or DEX administered singularly, a combination therapy with simultaneous administration of aflibercept and DEX was effective in resolving ME, despite the absence of visual improvement. Earlier combined treatment in the course of the disease might lead to better functional outcomes. Keywords Macular edema . Anti-VEGF . Dexamethasone . Aflibercept . Retinal vein occlusion
Introduction Retinal vein occlusion (RVO) is the second most common retinal vascular disorder after diabetic retinopathy [1]. Even though macular edema (ME) is the leading cause of visual loss in RVO patients, its pathogenesis is not completely understood, multiple factors contributing to disruption of the inner
* Maria Vittoria Cicinelli [email protected] 1
Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, via Olgettina 60, 20132 Milan, Italy
2
Ophthalmology Unit, Azienda Ospedaliera di Monza, Via G. B. Pergolesi, 33, 20900 Monza, Italy
blood-retinal barrier, vascular hyperpermeability, and increased local inflammatory response [2]. Therapeutic guidelines for ME secondary to RVO recom
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