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Non responders of treatment with antagonists of the vascular endothelial growth factor

Session Details

Session Title: AMD III

Session Date/Time: Sunday 29/09/2013 | 11:00-13:00

Paper Time: 12:52

Venue: Hall G1 (Level 2)

First Author: I.Krebs AUSTRIA

Co Author(s):    C. Glittenberg   S. Hagen   S. Ansari-Shahrezaei   S. Binder     

Abstract Details

Purpose:

Most of the publications concerning modern therapy of neovascular age-related macular degeneration focus on the effect of the treatment. This study should evaluate the incidence of non-responders to Anti Vascular Endothelial Growth Factor (anti-VEGF) treatment and find possible purposes.

Setting:

The records of patients treated until the end of 2008 the first time either with either Bevacizumab or Ranibizumab were reviewed.

Methods:

Loss of three lines of distance acuity (ETDRS charts), increase of retinal thickness (512x128 cube scans of Cirrus OCT) or lesion size (Spectralis HRA OCT, Heidelberger engeneering) were identified as indicators of non-responders. Two of these three signs had to be present. Mixed models including age, gender, anti-VEGF agent, distance acuity, retinal thickness, type of lesion, and morphologic features (bleeding, fibrosis, vitreo-macular adhesion) were calculated.

Results:

334 eyes of 284 patients were included, 74.55% received Bevacizumab, 25.45% Ranibizumab. Overall 14.37% of the eyes were identified as non-responders, (14.06% in the Bevacizumab, and 15.29% in the Ranibizumab group). Baseline distance acuity and vitreo-retinal adhesions were significantly correlated to non-responders. Correlations to age, gender, lesion type, other morphologic features, and the kind of anti-VEGF agent failed to be significant. 10.4% of the non-responders showed a delayed but good response to anti-VEGF treatment.

Conclusions:

About 15% did not sufficiently respond to anti-VEGF treatment. Although VEGF is the most important promoter of neovascular AMD, other cytokines or inflammatory processes might be more import in the pathogenesis of these cases. Vitreo-retinal adherences were the only ophthalmologic factor which could be identified to be significantly correlated to insufficient response.

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