BACKGROUND A significant proportion of eyes with polypoidal choroidal vasculopathy (PCV) can be resistant to anti-vascular endothelial growth factor (VEGF) injections. We evaluated the efficacy of a combination of dexamethasone intravitreal implant (DXI) and anti-VEGF therapy in eyes resistant to anti-VEGF monotherapy. METHODS In this retrospective study, patients with PCV resistant to anti-VEGF injections were additionally injected with a DXI along with an anti-VEGF agent. Best-corrected visual acuity (BCVA), slit-lamp examination, fundus evaluation, and optical coherence tomography (OCT) data were analyzed. Anatomical response on OCT was the primary outcome measure. Change in visual acuity and injection-free interval after DXI were evaluated as secondary outcome measures. RESULTS Twelve eyes of 11 patients were included in the study. Mean age of patients at presentation was 64.7 ± 9.5 years (range, 49-78.8 years), and there were seven females (63.6%). Median number of anti-VEGF injections prior to DXI was 4 (interquartile range IQR, 3-7). Median follow-up duration after DXI was 32.2 months (IQR, 6.6-41.6 months). Median logMAR BCVA immediately prior to DXI was 0.41 (IQR, 0.30-0.88) and after injection was 0.40 (IQR, 0.30-1.05), which was not significantly different (p = 0.85). Median Central Retinal Thickness (CRT) after DXI was 305.5 µm (IQR, 249-409 µm), which was significantly (p = 0.003) lesser than pre-injection thickness of 547 µm (IQR, 431-771 µm). Median injection-free interval in these eyes after DXI was 5 months (IQR, 2.8-6.4 months). Kaplan-Meier estimates of first injection after DXI were 27.3% at 3 months, 67.3% at 6 months, and 89.1% at 12 months. CONCLUSIONS Dexamethasone implant combined with anti-VEGF treatment can prolong the treatment-free interval in eyes with PCV resistant to anti-VEGF injection while maintaining visual acuity.

中文翻译：

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地塞米松植入物可改善难治性息肉状脉络膜血管病中抗 VEGF 治疗的解剖学反应。

背景大部分患有息肉状脉络膜血管病（PCV）的眼睛可能对抗血管内皮生长因子（VEGF）注射产生抗药性。我们评估了地塞米松玻璃体内植入物 (DXI) 和抗 VEGF 治疗联合对抗 VEGF 单一疗法耐药的眼睛的疗效。方法 在这项回顾性研究中，对抗 VEGF 注射耐药的 PCV 患者额外注射了 DXI 和抗 VEGF 药物。分析了最佳矫正视力 (BCVA)、裂隙灯检查、眼底评估和光学相干断层扫描 (OCT) 数据。OCT 的解剖反应是主要的结果测量。DXI 后视力和无注射间隔的变化被评估为次要结果指标。结果 11 名患者的 12 只眼被纳入研究。就诊患者的平均年龄为 64.7 ± 9.5 岁（范围为 49-78.8 岁），其中有 7 名女性（63.6%）。DXI 前抗 VEGF 注射的中位数为 4（四分位距 IQR，3-7）。DXI 后的中位随访时间为 32.2 个月（IQR，6.6-41.6 个月）。DXI 前的中位 logMAR BCVA 为 0.41（IQR，0.30-0.88），注射后为 0.40（IQR，0.30-1.05），差异无显着性（p = 0.85）。DXI 后中央视网膜厚度 (CRT) 为 305.5 µm (IQR, 249-409 µm)，显着 (p = 0.003) 小于注射前厚度 547 µm (IQR, 431-771 µm)。DXI 后这些眼睛的中位无注射间隔为 5 个月（IQR，2.8-6.4 个月）。Kaplan-Meier 估计 DXI 后第一次注射在 3 个月时为 27.3%，在 6 个月时为 67.3%，在 12 个月时为 89.1%。