In eyes with chronic DME despite frequent anti-VEGF, what is your threshold to add or switch to intravitreal steroid therapy?  

I am thinking about switching after three injections if I don't see a substantial (i.e.,> 50%) reduction in edema. I may try to go to a 2nd generation agent (usually faricimab) if I don't see a 50% reduction after the 1st injection --- by getting to faricimab early, I am able to make the switch t...

I’m quick to add steroids to anti-VEGF treatment. If there is little to no response to 3 anti-VEGF injections, adding a dexamethasone implant (Ozurdex) can help a lot. I will usually do that before switching in class. I usually switch to a different anti-VEGF if there is good but incomplete re...