Bevacizumab simultaneous combined with dexamethasone implant for treatment of neovascular serous retinal pigment epithelial detachment secondary to neovascular age-related macular degeneration

Purpose: To evaluate the add-on effect of simultaneous intravitreal dexamethasone implant to bevacizumab for treatment of neovascular serous retinal pigment epithelial detachment (PED) secondary to neovascular age-related macular degeneration (nAMD). Methods: A 72-year-old male patient was previously treated with intravitreal bevacizumab and aflibercept for neovascular serous PED secondary to nAMD. Because of the recurrences in neovascular PED patient was treated with simultaneous intravitreal injection of bevacizumab and dexamethasone implant. Results: At the initial visit, the patient's the best corrected visual acuity (BCVA) in the left eye was 20/800. His left eye had neovascular serous PED with a height of 1100 mu m and a largest linear diameter of 3953 mu m accompanied by subretinal fluid. He received four intravitreal bevacizumab and five intravitreal aflibercept injections. Although there was a decrease in PED sizes from time to time during the 16-month treatment period, PED height was 926 mu m and PED greatest linear diameter was 5820 mu m at the end of 16th month. Later, the patient could not have an injection for 3 months (he could not come to his controls during the pandemic period), and when he arrived 3 months later, the PED height was 910 mu m and the greatest linear diameter was 5830 mu m. With a single simultaneous intravitreal injection of bevacizumab and dexamethasone implant, the PED regressed to 168 mu m in height after 3 months. The BCVA increased to 20/200. Any clinical toxic effects did not occur and intraocular pressure did not rise for 3 months after injection. Conclusion: Simultaneous intravitreal bevacizumab and dexamethasone implant injection effectively and safely treated treatment-resistant neovascular serous PED. This therapy may be a novel alternative therapy for treatment resistant neovascular serous PED secondary to nAMD. However, further studies are required to understand its effectiveness and safety.

Automated summary

Simultaneous intravitreal injection of bevacizumab and dexamethasone implant effectively treated treatment-resistant neovascular serous pigment epithelial detachment, leading to a significant reduction in detachment height and improved visual acuity. Further studies are needed to confirm the effectiveness and safety of this novel treatment approach.