Intravitreal Dexamethasone as a Rescue for Anti-Vascular Endothelial Growth Factor Therapy in Neovascular Age-Related Macular Degeneration with Persistent Disease Activity and High Treatment Demand.
Détails
ID Serval
serval:BIB_B612DB5BAB1F
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Intravitreal Dexamethasone as a Rescue for Anti-Vascular Endothelial Growth Factor Therapy in Neovascular Age-Related Macular Degeneration with Persistent Disease Activity and High Treatment Demand.
Périodique
Journal of ocular pharmacology and therapeutics
ISSN
1557-7732 (Electronic)
ISSN-L
1080-7683
Statut éditorial
Publié
Date de publication
2024
Peer-reviewed
Oui
Volume
40
Numéro
6
Pages
361-369
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
Publication Status: ppublish
Résumé
Purpose: To assess the impact of switching to, or adding, an intravitreal dexamethasone implant (Dex; Ozurdex <sup>®</sup> ) in anti-vascular endothelial growth factor (VEGF) therapy on disease stability and treatment intervals in eyes with neovascular age-related macular degeneration (nAMD) and persistent disease activity and high treatment demand. Methods: This retrospective noncomparative multicenter longitudinal case series included pseudophakic eyes with nAMD and persistent retinal fluid despite regular anti-VEGF therapy (ranibizumab or aflibercept) that received at least 1 intravitreal Dex implant. Visual acuity, central retinal thickness (CRT), and intraocular pressure were recorded before, and after, the addition of Dex to anti-VEGF therapy. Results: Sixteen eyes of 16 patients met the inclusion criteria of persistent fluid despite anti-VEGF therapy, under treatment intervals of ≤7 weeks in 14 instances. Patients were 80.9 ± 7.4 years old and had received 25.5 ± 17.4 anti-VEGF injections before Dex over a period of 36.4 ± 21.9 months before switching. The treatment interval increased from 5.5 ± 3.2 weeks between the last anti-VEGF and first Dex injection to 11.7 ± 7.3 weeks thereafter (P = 0.022). CRT remained stable (385.3 ± 152.1, 383.9 ± 129.7, and 458.3 ± 155.2 μm before switching as well as 12 and 24 months after switching; P = 0.78 and P = 0.36, respectively). An insignificant mean short-term early increase in visual acuity was not sustained over time. Conclusions: The addition of Dex resulted in a relevant and sustained increase in treatment intervals, whereas CRT and visual acuity remained stable in these difficult-to-treat eyes. It may be discussed whether inflammation or other steroid-responsive factors play a significant role in cases of nAMD with nonsatisfactory responses to anti-VEGF.
Mots-clé
Humans, Dexamethasone/administration & dosage, Dexamethasone/therapeutic use, Retrospective Studies, Male, Intravitreal Injections, Female, Aged, 80 and over, Aged, Vascular Endothelial Growth Factor A/antagonists & inhibitors, Ranibizumab/administration & dosage, Ranibizumab/therapeutic use, Angiogenesis Inhibitors/administration & dosage, Angiogenesis Inhibitors/therapeutic use, Visual Acuity/drug effects, Macular Degeneration/drug therapy, Receptors, Vascular Endothelial Growth Factor/administration & dosage, Receptors, Vascular Endothelial Growth Factor/therapeutic use, Drug Implants, Recombinant Fusion Proteins/administration & dosage, Recombinant Fusion Proteins/therapeutic use, Glucocorticoids/administration & dosage, Glucocorticoids/therapeutic use, Wet Macular Degeneration/drug therapy, Longitudinal Studies, Ozurdex, burden of treatment, dexamethasone implant, disease stability, intravitreal anti-VEGF therapy, neovascular age-related macular degeneration
Pubmed
Web of science
Création de la notice
21/12/2023 15:51
Dernière modification de la notice
27/08/2024 6:19