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

Background and Objective: 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). Patients and Methods: 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). Results: 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. Conclusion: 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.