Anti-VEGF-refractory Exudative Age-related Macular Degeneration: Differential Response According to Features on Optical Coherence Tomography
Korean Journal of Ophthalmology
;
: 425-432, 2013.
Article
in English
| WPRIM
| ID: wpr-205016
ABSTRACT
PURPOSE:
To describe optical coherence tomography (OCT) characteristics of neovascular age-related macular degeneration (AMD) patients refractory to intravitreal anti-vascular endothelial growth factor (VEGF) injections (ranibizumab, bevacizumab) and their responses to alternative anti-VEGF agents or photodynamic therapy (PDT).METHODS:
A retrospective review of 267 neovascular AMD patients treated with intravitreal anti-VEGF injections.RESULTS:
Twenty patients (7.5%) were refractory to anti-VEGF injections (stationary or increased retinal exudation despite three or more monthly injections). They were grouped into either the extensive intraretinal fluid group (IRF group, 9 patients) or the subretinal fluid only group (SRF group, 11 patients) according to OCT findings. In the IRF group, response rates to subsequent treatment were 0% (0 / 7) for bevacizumab, 50% (3 / 6) for ranibizumab and 50% (3 / 6) for PDT +/- anti-VEGF. Three out of four bevacizumab-refractory patients showed response to ranibizumab as a secondary treatment. In the SRF group, response rates were lower with 0% (0 / 7) for bevacizumab, 22.2% (2 / 9) for ranibizumab and 28.6% (2 / 7) for PDT +/- anti-VEGF. One out of four bevacizumab-refractory patients responded to ranibizumab. The visual outcome was worse in the IRF group (median 20 / 1,000) than in the SRF group (median 20 / 100).CONCLUSIONS:
In anti-VEGF-refractory neovascular AMD, patients with extensive IRF refractory to bevacizumab can be responsive to ranibizumab while patients with SRF may be refractory to both, suggesting a different pathophysiology and intraocular pharmacokinetics.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Fluorescein Angiography
/
Visual Acuity
/
Retrospective Studies
/
Follow-Up Studies
/
Treatment Outcome
/
Angiogenesis Inhibitors
/
Vascular Endothelial Growth Factor A
/
Tomography, Optical Coherence
/
Wet Macular Degeneration
/
Intravitreal Injections
Type of study:
Observational study
/
Prognostic study
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Language:
English
Journal:
Korean Journal of Ophthalmology
Year:
2013
Type:
Article
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