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Mohammad Zubair Arain, Quan Hoang, Jason Slakter, Stanley Chang; Approach to Previously Vitrectomized Patients with Neovascular Age-Related Macular Degeneration with Reduced Response to Anti-vascular Endothelial Growth Factor Treatment. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4135.
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Post-vitrectomized patients with neovascular age-related macular degeneration (NVAMD) have been noted to have a reduced response to anti-vascular endothelial growth (anti-VEGF) injections. We describe a clinical approach to address this commonly encountered scenario.
A retrospective review was performed of the clinical histories and multimodal imaging findings of previously vitrectomized patients who then were diagnosed with NVAMD and deemed to have inadequate response to monthly anti-VEGF injections based on fundoscopy and optical coherence tomography (OCT).
3 eyes of 3 female patients (aged 63, 67 and 79 years old) were previously vitrectomized for repair of macular hole or macular pucker and subsequently diagnosed with NVAMD, inadequately-controlled with monthly ranibizumab injections. One patient achieved adequate response with ranibizumab every two weeks. All 3 patients responded to aflibercept (VEGF trap) injections with treatment intervals of 4-8 weeks. Best corrected visual acuity (BCVA) before transition to aflibercept treatment were 20/400, 20/70 and 20/40 and central subfoveal thickness (CST) was 618, 320 and 575 microns, respectively. After transitioning to aflibercept treatment, BCVA improved 3 +/- 1.7 lines (mean +/- standard deviation) to 20/150, 20/25 and 20/25, and CST decreased by 140 +/- 88 microns.
NVAMD patients who have undergone previous vitrectomy are responsive to anti-VEGF agents, but have a shorter drug half-life in the vitreous cavity. These eyes may require more frequent injections or agents with higher affinity for vascular endothelial growth factor.
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