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Roberto Gallego-Pinazo, Vinnie Shah, K Bailey Freund; Growth of Type 1 Neovascularization Following Cessation of Anti-Vascular Endothelial Growth Factor Therapy as a Possible Explanation for Treatment Resistance. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3807. doi: https://doi.org/.
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To demonstrate a possible mechanism of resistance to vascular endothelial growth factor (VEGF) inhibition in neovascular age-related macular degeneration (NVAMD) using serial eye-tracked spectral-domain optical coherence tomography (SD-OCT) imaging (Heidelberg Engineering, Heidelberg, Germany).
Retrospective review of the clinical histories and eye-tracked SD-OCT imaging findings in 2 eyes with NVAMD that developed recurrent and refractory subretinal fluid after cessation of anti-VEGF medication.
Case 1 was an 86-year-old female who was treated with 4 monthly intravitreal injections of ranibizumab in her left eye for type 1 neovascularization secondary to NVAMD. Resolution of all fluid and reduction in lesion size were evidenced by SD-OCT, and thereafter the patient was switched to OCT-guided therapy with a pro re nata dosing regimen. Eleven months after the last injection, subretinal fluid was noted to recur on SD-OCT. Case 2 was an 87-year-old male who was treated with 3 monthly intravitreal injections of ranibizumab in his left eye for type 1 neovascularization secondary to NVAMD, with resolution of a serous pigment epithelial detachment, consolidation of type 1 neovascular tissue and disappearance of all fluid on SD-OCT. The patient was then managed with a treat and extend dosing receiving 12 additional injections over the following 21 months. As there was no recurrent fluid noted during this period, the patient requested to be switched to an OCT-guided pro re nata dosing regimen. Twenty-seven months after the last injection, recurrent fluid was detected on SD-OCT. In both cases, serial eye-tracked SD-OCT imaging documented an increase in the type 1 neovascularization lesion size with following discontinuation of anti-VEGF therapy. When fluid recurred, reinstitution of monthly treatment with intravitreal ranibizumab followed by aflibercept was ineffective in resolving the exudation.
Serial eye-tracked SD-OCT imaging can detect slow growth of type 1 neovascularization in NVAMD following cessation of anti-VEGF therapy that may represent a possible mechanism for eyes becoming refractory to these agents.
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