First Author: R.Mendis AUSTRALIA
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Choroidal neovascularization (CNV) and cancer are two pathological conditions dependent on vascular endothelial growth factor (VEGF) for progression. Systemic VEGF production is required and augmented in cancer. It is possible that this increased systemic production could induce, augment and sustain secondary CNV from any cause. Furthermore this could also lead to poor response to anti-VEGF agents in the standard dose. There is paucity in the literature documenting this association.
This was a descriptive study of consecutive patients presenting with CNV and cancer or patients while on treatment for CNV who developed cancer between 2012 and 2015, at the Canberra Retina Clinic, Canberra, Australia.
This was a retrospective case series.
Nine patients with CNV secondary age related macular degeneration (AMD), myopia and chronic central serous retinopathy (CCSR) were identified. CNV was confirmed with standard imaging studies that included fluorescein angiography and spectral domain ocular coherence tomography. The cancer type, stage, treatment and temporal relation to CNV presentation were obtained from case record. Refractory response to anti-VEGF agents in patients with CNV was defined as persistence of subretinal and intraretinal fluid on a monthly treatment schedule with the standard dose of these agents. Similar response was recorded with all three commercially available anti-VEGF agents. Of the nine patients seven patients had CNV secondary to AMD. Of these two patients had bilateral wet AMD. One patient had CNV secondary to myopia and the other patient had CNV secondary to CCSR. The male female distribution was 50% in patients with AMD. The patient demographic data, imaging data, cancer type, treatment and neovascular AMD subtype and anti-VEGF agent used were recorded and are detailed in table 1 and figure 1.
Active cancer of any type was associated with a poor response to anti-VEGF agents in this group of patients with CNV secondary to AMD, CCSR and myopia. Treatment and remission from cancer was associated with better response to anti-VEGF treatment. These results require further investigation as these patients may benefit from dose escalation for control.