Combination Intravitreal Steroid and Anti-VEGF Therapy for Double-Monotherapy-Resistant Chronic Diabetic Macular...

The purpose of this retrospective chart review was to evaluate the efficacy and safety of combined intravitreal long-acting corticosteroids and anti-vascular endothelial growth factor (anti-VEGF) therapeutic agents for resistant cystoid macular edema associated with diabetic retinopathy, or diabetic macular edema (DME).

This study included 16 eyes of 15 patients. Patients with unresponsive DME, despite aggressive monthly monotherapy with steroid or anti-VEGF (decanted triamcinolone or 4 mg aflibercept) were included. Treatment consisted of simultaneous administration of anti-VEGF and decanted triamcinolone. Optical coherence tomography (OCT) and comprehensive ophthalmic exams were performed prior to treatment, as well as every 4 weeks (for 4 months), post-treatment. Main outcome measures were central retinal thickness (CRT) measured by OCT in microns and best-corrected visual acuity (BCVA).

The mean treated disease duration (months) was 38.93 ± SD 8.73 [16-108]. There was a CRT reduction at post-combination 1 month (159.18 µm, P = 0.0003), 2 month (169.58 µm, P = 0.0038), 3 month visit (167.88 µm, P = 00.0200), and 4 month (212.88 µm, P = 0.0276). BCVA improved by 8.5 letters (P = 0.0216) at month 1. Improvement persisted with a mean of nine letters (P = 0.039) at month 2, 10 letters (P = 0.035) at month 3, and three letters (P = 0.638) at month 4. No ocular or systemic safety issues were noted after the combination therapy.

Combination therapy of steroid and anti-VEGF results in clear anatomic and function improvement in eyes with DME that were resistant to monotherapy with anti-VEGF or monotherapy with steroids. The use of this combination has shown a therapeutic effect in treatment-resistant DME.