First Author: V.Poposki SPAIN
Co Author(s): A. Martinez-Palmer F. Dolz D. Poposka D. Vilaplana
Back to previous
Anti-VEGF is first choice treatment in exudative AMD. Recent stroke has been considered an exclusion criterion in most clinical trials because, theoretically, antiangiogenics are able to cause it. There is controversy over whether its frequent use increases the incidence of stroke. Intraocular corticosteroids have been widely used in the control of intraocular inflammation and inhibition of neovascularization, with different mechanism of action than anti-VEGF. Its use in exudative AMD is performed, mainly in combination treatments, when there is anti-VEGF resistance or tachyphylaxis.
Hospital de la Esperanza y del Mar - Park de Salut Mar
An 81-year-old male, with a history of hypertension, bilateral pseudophakia and atrophic AMD in right eye, presented central metamorphosis in his left eye (the only eye) with a 24-hour evolution. Visual acuity (ETDRS): 45 letters at 2 meters. At the exploration, funduscopically and tomographically, a neovascular membrane image was observed. Treatment with aflibercept was initiated but, soon after the third injection, the patient developed acute stroke. He remained in observation, but because of re-appearance of neovascular activity signs dexamethasone implant was used 'off-label'.
At the control, ETDRS was maintained at 45 letters and the juxtalesional serous retinal detachment disappeared.
There is currently no evidence supporting the use of anti-VEGF in patients with exudative AMD with a history of recent stroke. It is necessary to individualize each case and weigh the risks and benefits. By obtaining anatomical improvement in this particular patient the dexamethasone implant has allowed functional stability and maintenance of disease control.