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


ABSTRACT

Purpose:

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.

Results:

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.

Conclusion:

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.


CONTACT DETAILS

 

Rita Soyeur, Frédéric Hamon
St Jean de Luz & Biarritz, France
Email: hamonpro@gmail.com