Intravitreal Bevacizumab Non-responders For Treatment Of Wet Age-related Macular Degeneration

1. Kuo Luong Lee
2. David Squirrell

Department of Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand

Purpose: To define the characteristics of intravitreal bevacizumab (IVB) non-responders who were treated for wet age-related macular degeneration (AMD).

Methods: Consecutive patients who failed to respond to IVB treatments for wet AMD over a one-year period at a large tertiary referral center were identified. IVB non-responders are defined as those patients whose intra retinal oedema or subretinal fluid failed to resolve or had worsened despite an intensive course of at least 3 consecutive monthly IVB treatments. Patients who failed IVB therapy underwent further evaluation with ICGA, unless a polyp was clearly visualized. Patients were excluded from the analysis if they had end stage disease with structural damage affecting the fovea.

Results: 22 eyes of 22 patients were identified (16 females, 6 males). The mean age was 75.9 years. The ethnicity of 19 patients was European, 1 was Middle Eastern and 2 Asian. Median number of treatments was 7 (range 3 to 21). The final diagnoses of these 22 patients were: polypoidal choroidal vasculopathy (PCV) 11 patients (50%); occult choroidal neovascular membrane (CNVM) 10 patients (45%); pseudovitelliform dystrophy 1 patient (5%). 3 of the 10 patients with occult CNVM were subsequently treated with intravitreal ranibizumab. All 3 patients so treated experienced a prompt response with resolution of fluid and improved vision within 2 treatments.

Conclusions: A small proportion of patients with wet AMD do not respond to IVB. IVB non-responders should undergo ICG to guide further treatment and prognosis. True occult CNVM should be offered intravitreal ranibizumab as rescue therapy.