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Mark Nelson; Persistent Leakage During the Course of Anti-VEGF Monotherapy - Etiology and Treatment. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3803.
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Determine the cause of persistent leakage in patients treated with anti-VEGF monotherapy
Retrospective evaluation of 64 treatment-naive patients with Exudative ARMD who comprised two treatment groups: Monthly (24 months of monthly ranibizumab) and Treat and Extend (12 months of monthly ranibizumab, followed by 12 months of a 'treat and extend' protocol. Pre-treatment evaluation of each patient included ICG/IVFA/OCT multimodality imaging. Post-treatment followup included monthly OCT and every three month ICG imaging.
10% of patients from all groups were classified as Primary Anti-VEGF Failures (failed induction). 10% of patients in the Monthly group developed recurrent leakage, defined as a Secondary Anti-VEGF Failures. 20% of patients in the Treat and Extend group became Secondary Anti-VEGF Failures. All patients with recurrent leakage had ICG-identifiable lesions. All patients were treated with rescue protocols: increased ranibizumab frequency, aflibercept monotherapy, or ICG-Directed PDT Triple Therapy.
ICG multimodality imaging is critical to determine the etiology of the persistent leakage and to create a strategy for exudative and neovascular resolution.
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