Anti-VEGF-refractory Exudative Age-related Macular Degeneration: Differential Response According to Features on Optical Coherence Tomography.
10.3341/kjo.2013.27.6.425
- Author:
Joo Young SHIN
1
;
Se Joon WOO
;
Jeeyun AHN
;
Kyu Hyung PARK
Author Information
1. Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. sejoon1@hanmail.net
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Bevacizumab;
Drug resistance;
Macular degeneration;
Optical coherence tomography;
Ranibizumab
- MeSH:
Aged;
Aged, 80 and over;
Angiogenesis Inhibitors/administration & dosage;
Antibodies, Monoclonal, Humanized/*administration & dosage;
Female;
Fluorescein Angiography;
Follow-Up Studies;
Fundus Oculi;
Humans;
Intravitreal Injections;
Male;
Middle Aged;
Retrospective Studies;
Tomography, Optical Coherence/*methods;
Treatment Outcome;
Vascular Endothelial Growth Factor A/*antagonists & inhibitors;
Visual Acuity;
Wet Macular Degeneration/*drug therapy/metabolism/pathology
- From:Korean Journal of Ophthalmology
2013;27(6):425-432
- CountryRepublic of Korea
- Language:English
-
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.
