Intravitreal dexamethasone implant shows promise in addressing persistent neovascular AMD

The addition of intravitreal dexamethasone implant (Dex; Ozurdex) to the treatment regimen of patients with neovascular age-related macular degeneration (nAMD) with persistent disease activity and high treatment demand resulted in a significant and sustained increase in treatment intervals, according to a study. Despite the longer treatment intervals, central retinal thickness (CRT) remained stable, suggesting that the implant may contribute to disease stability. However, visual acuity did not show sustained improvement over time.

The study, which included 16 pseudophakic eyes of 16 patients, focused on individuals with nAMD exhibiting persistent retinal fluid despite consistent anti-VEGF therapy with ranibizumab or aflibercept. The patients, with an average age of 80.9 ± 7.4 years, had undergone an average of 25.5 ± 17.4 anti-VEGF injections over a period of 36.4 ± 21.9 months before switching to intravitreal Dex.

There was a notable and sustained increase in treatment intervals after the addition of Dex. The treatment interval increased from an average of 5.5 ± 3.2 weeks between the last anti-VEGF and the first Dex injection to 11.7 ± 7.3 weeks thereafter (P = 0.022).

Despite the increase in treatment intervals, CRT remained stable throughout the study period. Measurements taken before switching, as well as at 12 and 24 months post-switching, showed no significant differences (385.3 ± 152.1, 383.9 ± 129.7, and 458.3 ± 155.2 μm respectively; P = 0.78 and P = 0.36).

Visual acuity, while showing an insignificant mean short-term early increase after the addition of Dex, did not exhibit sustained improvement over time.

Reference
Pietzuch M, Mantel I, Ambresin A, et al. 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. J Ocul Pharmacol Ther. 2023;doi: 10.1089/jop.2023.0105. Epub ahead of print. PMID: 38117666.