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

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 ۲۰۱۴ and July ۲۰۱۵ 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 (۱.۲۵ mg) and an intravitreal implant of dexamethasone (۰.۷ 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 ۲۴ hours after the treatment, and then followed up after ۳۰ days and ۶۰ days. Twenty patients (representing ۲۰ eyes) were included in the study. At the time of injection (i.e., baseline), the best-corrected visual acuity (BCVA) was ۰.۷۵۸ ± ۰.۴۲ logarithm of the minimum angle of resolution (logMAR). It improved significantly to ۰.۵۱ ± ۰.۳۳ logMAR at ۱ month and to ۰.۵ ± ۰.۳۴ logMAR at ۲ months (P ≤ ۰.۰۳). The median baseline central macular thickness (CMT) was ۵۴۲ µm (interquartile range, ۴۶۶ – ۷۵۱ µm). The median CMT decreased significantly to ۳۲۱ µm (interquartile range, ۲۸۸–۳۸۱ µm) at ۱ month and ۳۱۰ µm (interquartile range, ۲۸۶ – ۳۵۴ µm) at ۲ months (P ≤ ۰.۰۰۰۲). The mean intraocular pressure (IOP) increased from ۱۴.۹ ± ۲.۲۹ mmHg (at baseline) to ۱۶.۵ ± ۲.۹۹ mmHg (P = ۰.۰۴) after ۲ months. Two (۱۰%) 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.