July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Systemic risk factors that may impinge on the therapeutic outcomes in neovascular age related macular degeneration treated with anti VEGF agents on a treat and extend regimen
Author Affiliations & Notes
  • Yi Fan Tang
    The Canberra Hospital, Garran, Australian Capital Territory, Australia
  • Kanishka Randev Mendis
    The Canberra Hospital, Garran, Australian Capital Territory, Australia
    Canberra Retina Clinic, Deakin, Australian Capital Territory, Australia
  • Footnotes
    Commercial Relationships   Yi Fan Tang, None; Kanishka Randev Mendis, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 813. doi:https://doi.org/
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      Yi Fan Tang, Kanishka Randev Mendis; Systemic risk factors that may impinge on the therapeutic outcomes in neovascular age related macular degeneration treated with anti VEGF agents on a treat and extend regimen. Invest. Ophthalmol. Vis. Sci. 2018;59(9):813. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Systemic conditions that lead to increased VEGF production may impact negatively with anti VEGF treatments for neovascular age related macular degeneration (NAMD). Malignancy, increased body mass index (BMI), wound healing, surgical procedures and inflammatory conditions have all been known to augment systemic production of VEGF. Neovascular AMD patients with these systemic conditions may require more systemic vigilance in addition to ocular outcome criteria in the therapeutic decisions and treatment scheduling.

The study was conducted to identify, risk stratify systemic risk factors and impact on anti VEGF therapeutic outcomes NAMD.

Methods : A retrospective review of patients treated with anti VEGF agents for NAMD with recurrent disease activity at Canberra Retina Clinic, Canberra Australia, between 2015 to 2017. NAMD were diagnosed with standard imaging techniques. Recurrent NAMD activity was defined as recurrence of subretinal fluid (SRF), intra retinal fluid (IRF) and new macular bleed after a period of resolution on a treat and extend approach. The temporal relation of the recurrence of NAMD activity was correlated with changes patient’s general medical comorbidities.

Results : There were 17 patients identified as having recurrent NAMD after a period of resolution on a treat and extend approach. Of the 17 patients in the series 9 (53%) were female, there were 10 (67%) right eyes and 2 patients were bilateral NAMD. The average age of the patients was 76 years (range, 55-90 years). Seven patients were being treated for active malignancy. Four patients had a history of poorly controlled inflammatory arthropathies. Four patients had BMI over 30. One patient had ongoing non-healing legs wounds and another had recurrent shoulder dislocations requiring reductions.

Conclusions : In this group of patients we were able to identify/risk stratify systemic risk factors that lead to recurrence of active NAMD. These in order of risk were active malignancy, would healing, inflammatory arthropathies, higher BMI and surgical procedures. Increased vigillence of these systemic risk factors may be required particularly in a treat and extend treat paradigm as the extension of treatment, in addition to ocular factors, may also be impacted by systemic risk factors.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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