J Korean Ophthalmol Soc.  2010 Nov;51(11):1464-1470. 10.3341/jkos.2010.51.11.1464.

Anatomical Non-Responder to Intravitreal Bevacizumab for Neovascular Age-Related Macular Degeneration

• Cho SW
• Bae JH
• Song SJ

• KMID: 2213970
• DOI: http://doi.org/10.3341/jkos.2010.51.11.1464

Abstract

PURPOSE
To analyze the characteristics of anatomical non-response to intravitreal bevacizumab (IVB) in patients with neovascular age-related macular degeneration (AMD).
METHODS
Neovascular AMD patients who were treated with IVB were studied. A non-responder was defined as a patient whose eyes had no change in choroidal neovascularization (CNV) lesion size or fluorescein leakage and no change in foveal thickness (FT) after at least two administrations of IVB. Demographic findings and efficacy outcomes were compared between responders and non-responders based on patient gender, age, visual acuity (VA), FT, CNV lesion type, CNV lesion size, presence of serous retinal detachment (SRD), presence of pigment epithelial detachment (PED), PED size, and presence of sub-macular hemorrhage (SMH).
RESULTS
Five patients (six eyes; 13.6%) were identified as non-responders to treatment with IVB. The mean age of the non-responder group (75.17 +/- 3.66 yers) was greater (p = 0.237) than that of the responder group (71.89 +/- 8.06 years), and the proportion of occult CNV (85.7% versus 55.3%, p = 0.375) was higher in the non-responder group, although there was no significant difference compared with that of the responder group. The PED size of the non-responder group (4.42 +/- 1.56 mm2) was significantly larger than that of the responder group (1.51 +/- 2.33 mm2, p = 0.001).
CONCLUSIONS
The authors report a group of patients in AMD with poor treatment response to IVB. The PED size of the non-responder group was confirmed to be significantly larger than that of the responder group.

Keyword

Age-related macular degeneration (AMD); Avastin; Bevacizumab; Non-responder

MeSH Terms

Antibodies, Monoclonal, Humanized
Choroidal Neovascularization
Eye
Fluorescein
Hemorrhage
Humans
Macular Degeneration
Retinal Detachment
Visual Acuity
Bevacizumab
Antibodies, Monoclonal, Humanized
Fluorescein

Figure

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  Figure 1. Non-responder to intravitreal bevacizumab in Case 1 (Left eye). (A-1) Fundus photograph (FP) before intravitreal bevacizumab injection. (A-2) Early phase of fundus fluorescein angiography (FAG) before intravitreal bevacizumab injection. (A-3) Late phase of FAG before intravitreal bevacizumab injection. (A-4) Optical coherence tomography (OCT) scan before intravitreal bevacizumab injection. (B-1) FP 3 months after intravitreal bevacizumab injection. (B-2) Early phase of FAG 3 months after intravitreal bevacizumab injection. (B-3) Late phase of FAG 3 months after intravitreal bevacizumab injection. (B-4) OCT scan 3 months after intravitreal bevacizumab injection.

• 

  Figure 2. Non-responder to intravitreal bevacizumab in Case 2 (Left eye). (A-1) Fundus photograph (FP) before intravitreal bevacizumab injection. (A-2) Early phase of fundus fluorescein angiography (FAG) before intravitreal bevacizumab injection. (A-3) Late phase of FAG before intravitreal bevacizumab injection. (A-4) Optical coherence tomography (OCT) scan before intravitreal bevacizumab injection. (B-1) FP 3 months after intravitreal bevacizumab injection. (B-2) Early phase of FAG 3 months after intravitreal bevacizumab injection. (B-3) Late phase of FAG 3 months after intravitreal bevacizumab injection. (B-4) OCT scan 3 months after intravitreal bevacizumab injection.

• 

  Figure 3. Responder to intravitreal bevacizumab in Case 3 (Left eye). (A-1) Fundus photograph (FP) before intravitreal bevacizumab injection. (A-2) Early phase of fundus fluorescein angiography (FAG) before intravitreal bevacizumab injection. (A-3) Late phase of FAG before intravitreal bevacizumab injection. (A-4) Optical coherence tomography (OCT) scan before intravitreal bevacizumab injection. (B-1) FP 3 months after intravitreal bevacizumab injection. (B-2) Early phase of FAG 3 months after intravitreal bevacizumab injection. (B-3) Late phase of FAG 3 months after intravitreal bevacizumab injection. (B-4) OCT scan 3 months after intravitreal bevacizumab injection.

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