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Anti-VEGF-refractory exudative age-related macular degeneration: differential response according to features on optical coherence tomography.
Korean J Ophthalmol 2013; 27(6):425-32KJ

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.

Authors+Show Affiliations

Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24311928

Citation

Shin, Joo Young, et al. "Anti-VEGF-refractory Exudative Age-related Macular Degeneration: Differential Response According to Features On Optical Coherence Tomography." Korean Journal of Ophthalmology : KJO, vol. 27, no. 6, 2013, pp. 425-32.
Shin JY, Woo SJ, Ahn J, et al. Anti-VEGF-refractory exudative age-related macular degeneration: differential response according to features on optical coherence tomography. Korean J Ophthalmol. 2013;27(6):425-32.
Shin, J. Y., Woo, S. J., Ahn, J., & Park, K. H. (2013). Anti-VEGF-refractory exudative age-related macular degeneration: differential response according to features on optical coherence tomography. Korean Journal of Ophthalmology : KJO, 27(6), pp. 425-32. doi:10.3341/kjo.2013.27.6.425.
Shin JY, et al. Anti-VEGF-refractory Exudative Age-related Macular Degeneration: Differential Response According to Features On Optical Coherence Tomography. Korean J Ophthalmol. 2013;27(6):425-32. PubMed PMID: 24311928.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anti-VEGF-refractory exudative age-related macular degeneration: differential response according to features on optical coherence tomography. AU - Shin,Joo Young, AU - Woo,Se Joon, AU - Ahn,Jeeyun, AU - Park,Kyu Hyung, Y1 - 2013/11/15/ PY - 2012/08/21/received PY - 2013/01/29/accepted PY - 2013/12/7/entrez PY - 2013/12/7/pubmed PY - 2015/4/14/medline KW - Bevacizumab KW - Drug resistance KW - Macular degeneration KW - Optical coherence tomography KW - Ranibizumab SP - 425 EP - 32 JF - Korean journal of ophthalmology : KJO JO - Korean J Ophthalmol VL - 27 IS - 6 N2 - 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. SN - 2092-9382 UR - https://www.unboundmedicine.com/medline/citation/24311928/Anti_VEGF_refractory_exudative_age_related_macular_degeneration:_differential_response_according_to_features_on_optical_coherence_tomography_ L2 - https://ekjo.org/DOIx.php?id=10.3341/kjo.2013.27.6.425 DB - PRIME DP - Unbound Medicine ER -