Combined Intravitreal Anti-VEGF & Subtenon Corticosteroids in AMD to Reduce ME Recurrence and Increase Delay Between IVTs: An Update and Some Lessons



To evaluate with time efficiency of combined treatment using Anti-VEGF & subtenon (or subconjonctival) corticosteroids in ME recurrence in AMD

Material & Methods:

All kinds of CNV in AMD were included in this retrospective study (classic, minimally classic, occult, PEDs…) Both Ranibizumab and Aflibercept were used and associated with subtenon (or subconjonctival) corticosteroids . Corticosteroid was mainly bethamethasome acetate vs sometimes triamcinolone acetonide. Subtenon (or subconjonctival)  corticosteroids and anti-VEGF IVT were both made during the same procedure.


This combined therapy seems to decrease ME recurrence and increase delay between IVTs required. Patients with chronic ME and no stabilization with Anti-VEGF (Ranibizumab or Aflibercept) alone still have better results with time. Using a subconjonctival corticosteroids injection (rather than a subtenon) didn’t change results. Some patients with many previous combined treatment but long time no-CNV recurrence became eligible to Anti-VEGF IVT efficiency again, without need to use corticosteroids. Some cases still remain unclear in 2017, with good or poor results in similar CNV but for different patients.


Using combined treatment in CNV for AMD should be considered, especially compared to automatic injection protocol. With huge reduce cost and number of treatment , it avoids a lot of multiple intravitreal injections for patients. Using a subconjonctival cortiocsteroid injection makes this combined treatment easier . Previous hypothesis of dependance effect with time to corticosteroids for patients with previous combined treatment seems no longer « cast in stone » : it could be related to Anti-VEGF receptors reactivation if CNV didn’t have had recurrence for a long time, leading to no more resistance to Anti-VEGF IVT without corticosteroids.



Rita Soyeur, Frédéric Hamon
St Jean de Luz & Biarritz, France