Simultaneous Therapy with Intravitreal Dexamethasone Implant and Bevacizumab for the Treatment of Macular Edema

Felipe L. de ANDRADE, Flavio S. LOPES, Gabriel C. de ANDRADE, Tiago S. PRATA, André MAIA

Abstract


To investigate the safety profile and benefits of a short-term simultaneous treatment regimen combining two drugs—an intravitreal implant of dexamethasone with an intravitreal injection of bevacizumab—in patients with macular edema. This was a retrospective, non-randomized, open-label case series study.  Patients were treated between April 2014 and July 2015 and were diagnosed with recurrent macular edema secondary to diabetic retinopathy and retinal vein occlusion. They underwent simultaneous treatment with an intravitreal injection of bevacizumab (1.25 mg) and an intravitreal implant of dexamethasone (0.7 mg). Patients were evaluated at baseline and at each subsequent visit with a complete ophthalmological examination and spectral-domain optical coherence tomography (OCT) scans. They were examined 24 hours after the treatment, and then followed up after 30 days and 60 days. Twenty patients (representing 20 eyes) were included in the study. At the time of injection (i.e., baseline), the best-corrected visual acuity (BCVA) was 0.758 ± 0.42 logarithm of the minimum angle of resolution (logMAR). It improved significantly to 0.51 ± 0.33 logMAR at 1 month and to 0.5 ± 0.34 logMAR at 2 months (P ≤ 0.03). The median baseline central macular thickness (CMT) was 542 µm (interquartile range, 466 – 751 µm). The median CMT decreased significantly to 321 µm (interquartile range, 288–381 µm) at 1 month and 310 µm (interquartile range, 286 – 354 µm) at 2 months (P ≤ 0.0002). The mean intraocular pressure (IOP) increased from 14.9 ± 2.29 mmHg (at baseline) to 16.5 ± 2.99 mmHg (P = 0.04) after 2 months. Two (10%) eyes showed cataract progression. There were no other ocular or systemic complications for the duration of this study. Simultaneous therapy combining a dexamethasone implant plus bevacizumab for macular edema may be an attractive treatment regimen with an acceptable safety profile.


References


Mayer WJ, Remy M, Wolf A, Kook D, Kampik A, Ulbig M, et al. Comparison of intravitreal bevacizumab upload followed by a dexamethasone implant versus dexamethasone implant monotherapy for retinal vein occlusion with macular edema. Ophthalmologica. 2012;228(2):110-6. PMID: 22739239

Singer MA, Bell DJ, Woods P, Pollard J, Boord T, Herro A, et al. Effect of combination therapy with bevacizumab and dexamethasone intravitreal implant in patients with retinal vein occlusion. Retina. 2012;32(7):1289-94. PMID: 22466480

Maturi RK, Bleau L, Saunders J, Mubasher M, Stewart MW. A 12-Month, Single-Masked, Randomized Controlled Study of Eyes with Persistent Diabetic Macular Edema after Multiple Anti-Vegf Injections to Assess the Efficacy of the Dexamethasone-Delayed Delivery System as an Adjunct to Bevacizumab Compared with Continued Bevacizumab Monotherapy. Retina. 2015;35(8):1604-14. PMID: 25829346

Mehta H, Gillies M, Fraser-Bell S. Perspective on the role of Ozurdex (dexamethasone intravitreal implant) in the management of diabetic macular oedema. Ther Adv Chronic Dis. 2015;6(5):234-45. PMID: 26336592

Boyer DS, Yoon YH, Belfort R, Jr., Bandello F, Maturi RK, Augustin AJ, et al. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology. 2014;121(10):1904-14. PMID: 24907062

Gado AS, Macky TA. Dexamethasone intravitreous implant versus bevacizumab for central retinal vein occlusion-related macular oedema: a prospective randomized comparison. Clin Exp Ophthalmol. 2014;42(7):650-5. PMID: 24612095

Nauck M, Karakiulakis G, Perruchoud AP, Papakonstantinou E, Roth M. Corticosteroids inhibit the expression of the vascular endothelial growth factor gene in human vascular smooth muscle cells. Eur J Pharmacol. 1998;341(2-3):309-15. PMID: 9543253

Haller JA, Bandello F, Belfort R, Jr., Blumenkranz MS, Gillies M, Heier J, et al. Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results. Ophthalmology. 2011;118(12):2453-60. PMID: 21764136

Vakalis N, Echiadis G, Pervena A, Deligiannis I,

Kavalarakis E, Giannikakis S, et al. Intravitreal combination of dexamethasone sodium phosphate and bevacizumab in the treatment of exudative AMD. Sci Rep. 2015;5:8627. PMID: 25720826

Callanan DG, Gupta S, Boyer DS, Ciulla TA, Singer MA, Kuppermann BD, et al. Dexamethasone intravitreal implant in combination with laser photocoagulation for the treatment of diffuse diabetic macular edema. Ophthalmology. 2013;120(9):1843-51. PMID: 23706947

Berger AR, Cruess AF, Altomare F, Chaudhary V, Colleaux K, Greve M, et al. Optimal Treatment of Retinal Vein Occlusion: Canadian Expert Consensus. Ophthalmologica. 2015;234(1):6-25. PMID: 26088287

Bhavsar AR, Googe JM, Jr., Stockdale CR, Bressler NM, Brucker AJ, Elman MJ, et al. Risk of endophthalmitis after intravitreal drug injection when topical antibiotics are not required: the diabetic retinopathy clinical research network laser-ranibizumab-triamcinolone clinical trials. Arch Ophthalmol. 2009;127(12):1581-3. PMID: 20008710

Kim MS, Kim JM, Park KH, Choi CY. Asymmetry of diurnal intraocular pressure fluctuation between right and left eyes. Acta Ophthalmol. 2011;89(4):352-7. PMID: 19860773

Lam WC, Albiani DA, Yoganathan P, Chen JC, Kherani A, Maberley DA, et al. Real-world assessment of intravitreal dexamethasone implant (0.7 mg) in patients with macular edema: the CHROME study. Clin Ophthalmol. 2015;9:1255-68. PMID: 26203215


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