Dear editor
I read with great interest the recent study by Michalska-Małecka et al1 published in the journal Clinical Interventions in Aging. The authors investigated the impact of intravitreal dexamethasone implant on macular morphology and functions in eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). I congratulate the authors for their enlightening study and would like to make some contributions to the study.
When treating BRVO or CRVO, first-line treatment is typically an anti-vascular endothelial growth factor (VEGF) agent. If this is inadequate, steroids can be initiated, either in combination with the anti-VEGF agent or alone. Steroids have significant anti-inflammatory actions that may incrementally benefit anti-VEGF blockade for the treatment of edema due to retinal vein occlusion (RVO). Dexamethasone intravitreal implants have also been shown to be a safe and effective treatment option. A recent study evaluated the safety and efficacy of one or two treatments over 12 months in eyes with ME related to BRVO or CRVO.2
However, I believe that combination therapy is very advantageous in patients with RVO. A recent study found that bevacizumab combined with dexamethasone implants produced greater improvements in macular thickness than bevacizumab therapy alone and required fewer bevacizumab injections in cases of both BRVO and CRVO.3 For patients who are already pseudophakic and who are not steroid responders, adding dexamethasone implant to a regimen of anti-VEGF injections is unlikely to significantly increase the risk of complications; less frequent treatments with combination therapy may be a palatable alternative to the more frequently administered anti-VEGF monotherapy.
I think that many doctors stick with anti-VEGF monotherapy longer than they should. Typically, patients’ response to anti-VEGF injections is evident early in the course of treatment. If patients show the inadequate response, I add the dexamethasone implant very early. I look forward to further studies that will better define the role of anti-VEGF combined with dexamethasone implant.
Footnotes
Disclosure
The author reports no conflict of interest in this communication.
References
- 1.Michalska-Małecka K, Gaborek A, Nowak M, Halat T, Pawłowska M, Śpiewak D. Evaluation of the effectiveness and safety of glucocorticoids intravitreal implant therapy in macular edema due to retinal vein occlusion. Clin Interv Aging. 2016;11:699–705. doi: 10.2147/CIA.S96674. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Haller JA, Bandello F, Belfort R, Jr, et al. Ozurdex GENEVA Study Group Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion: twelve-month study results. Ophthalmology. 2011;118(12):2453–2460. doi: 10.1016/j.ophtha.2011.05.014. [DOI] [PubMed] [Google Scholar]
- 3.Maturi RK, Chen V, Raghinaru D, Bleau L, Stewart MW. A 6-month, subject-masked, randomized controlled study to assess efficacy of dexamethasone as an adjunct to bevacizumab compared with bevacizumab alone in the treatment of patients with macular edema due to central or branch retinal vein occlusion. Clin Ophthalmol. 2014;8:1057–1064. doi: 10.2147/OPTH.S60159. [DOI] [PMC free article] [PubMed] [Google Scholar]