title: INTRAVITREAL DEXAMETHASONE IMPLANT AS ADJUVANT TREATMENT FOR BEVACIZUMAB- AND RANIBIZUMAB-RESISTANT NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: A Prospective Pilot Study.
abstract: OBJECTIVE
  To study the benefit of intravitreal dexamethasone implant in the management of neovascular age-related macular degeneration resistant to bevacizumab and ranibizumab.
  
  
  METHODS
  Patients with persistent macular fluid on optical coherence tomography despite monthly treatment with at least three consecutive bevacizumab injections followed by at least three ranibizumab injections were prospectively enrolled. A single dexamethasone implant was administered followed by intravitreal ranibizumab 1 week later. Ranibizumab was continued afterward on an as-needed basis. Main outcomes were improvement in central retinal thickness and best-corrected visual acuity.
  
  
  RESULTS
  Nineteen patients (19 eyes) were enrolled. There was no significant change in best-corrected visual acuity over 6 months. Greatest reduction in mean central retinal thickness, from 295.2 μm to 236.2 μm, occurred 1 month after dexamethasone implant (P < 0.0001). By Month 6, mean central retinal thickness was 287.3 μm (P = 0.16). Eyes with only intraretinal fluid (13 eyes) achieved a fluid-free macula. Eyes with predominantly subretinal fluid (6 eyes) did not improve central retinal thickness and continued monthly ranibizumab. Mean baseline intraocular pressure was 13.2 mmHg, which peaked at 15.6 mmHg by Month 2 (P = 0.004).
  
  
  CONCLUSIONS
  Intravitreal dexamethasone implant improved only macular intraretinal fluid in eyes with neovascular age-related macular degeneration resistant to bevacizumab and ranibizumab. However, this treatment had a limited duration.
authors: *Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; †Department of Ophthalmology, American Hospital of Dubai, Dubai, United Arab Emirates; and ‡Department of Health Policy and Research, Weill Cornell Medicine, Doha, Qatar.
authors: Anita
authors: A
authors: Barikian
authors: Haytham
authors: H
authors: Salti
authors: Ammar
authors: A
authors: Safar
authors: Ziyad R
authors: ZR
authors: Mahfoud
authors: Ziad F
authors: ZF
authors: Bashshur
mesh_terms: D000369:Aged, 80 and over; D000068258:Bevacizumab / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004343:Drug Implants; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D000069579:Ranibizumab / Q000008:administration & dosage*; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D004343:Drug Implants; D005938:Glucocorticoids; D000068258:Bevacizumab; D003907:Dexamethasone; D000069579:Ranibizumab