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J. L. Gasperini, A. Fawzi, L. Lam, L. Chong, D. Eliott, A. Walsh, S. Sadda; Bevacizumab and Ranibizumab Tachyphylaxis in the Treatment of Choroidal Neovascularization. Invest. Ophthalmol. Vis. Sci. 2008;49(13):346.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate patients with choroidal neovascularization(CNV) with poor initial morphologic response to ranibizumab or bevicizumab therapy, to determine if these patients respond after changing the treatment regimen to a different anti-vascular endothelial growth factor (VEGF) drug, bevacizumab or ranibizumab.
Retrospective chart review of patients treated for CNV at the Doheny Eye Institute from September 2006 through November 2007 with both ranibizumab and bevacizumab. OCT features of exudation [subretinal fluid (SRF), pigment epithelial detachment (PED), and/or cystoid macular edema (CME)] were evaluated during the course of therapy. Lack of reduction or an increase in exudation was considered evidence of poor response.
22 eyes of 23 patients were treated with both bevacizumab and ranibizumab for CNV. 6 of the 22 eyes were initially treated with bevacizumab. These eyes received on average 5 injections of bevacizumab prior to changing the treatment regimen to ranibizumab for non-responding SRF, PED, and/or CME. 2 of the 6 eyes were initially treated with bevacizumab for classic CNV and 4 eyes for an occult CNV with pigment epithelial detachment (PED). Of the 2 eyes with classic CNV, in one eye, SRF completely resolved after 4 ranibizumab injections, while the other eye is still undergoing treatment for improving but persistent SRF. All 4 eyes with occult CNV started to respond after 1 ranibizumab injection.17 of the 22 eyes were initially treated with ranibizumab. These eyes received on average 5 injections of ranibizumab prior to changing the treatment regimen to bevacizumab for poor response. On average, 3 injections of bevacizumab were administered. Of the 17 eyes initially treated with ranibizumab, 1 eye was treated for classic CNV and 16 eyes for occult CNV (14/16 eyes had PED). 3 eyes did not respond to the change to bevacizumab, while 9 eyes showed a response (reduction or resolution) after only 1 injection and 5 eyes after 2 injections.
Patients with CNV that show a poor initial response to ranibizumab or bevacizumab therapy may yield a better response after switching to another anti-VEGF drug. Some patients require multiple injections to demonstrate a treatment response.
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