The Effect of Bevacizumab on Corneal Neovascularization in Rabbits

Purpose

To determine the efficacy of topical application and subconjunctival injection of bevacizumab in the treatment of corneal neovascularization.

Methods

Corneal neovascularization was induced with a silk suture of the corneal stroma in 12 rabbits (24 eyes). One week after suturing, four rabbits were treated with topical bevacizumab at 5 mg/mL (group A) and another four rabbits were treated with topical bevacizumab 10 mg/mL (group B) in the right eyes twice a day for two weeks. A subconjunctival injection of bevacizumab 1.25 mg/mL was done in the right eyes of four rabbits (group C). All of the left eyes (12 eyes) were used as controls. The area of corneal neovascularization was measured after one and two weeks, and the concentration of vascular endothelial growth factor (VEGF) in corneal tissue was measured after two weeks.

Results

The neovascularized area was smaller in all treated groups than in the control group (p<0.001). Upon analysis of the neovascularized area, there was no significant difference between groups A and B. However, the mean neovascularized area of group B was significantly smaller than that of group C after two weeks of treatment (p=0.043). The histologic examination revealed fewer new corneal vessels in all treated groups than the control group. The concentration of VEGF was significantly lower in all treated groups compared to the control group (p<0.01), but no difference was shown between treated groups.

Conclusions

Topical and subconjunctival bevacizumab application may be useful in the treatment of corneal neovascularization and further study is necessary.     

Intracameral Avastin dramatically resolves iris neovascularization and reverses neovascular glaucoma

PURPOSE: To report the biologic effect of intracameral bevacizumab in patients with iris neovascularization secondary to proliferative retinal vasculopathies. METHODS: Sixteen eyes of 15 patients with iris neovascularization associated with or without neovascular glaucoma secondary to proliferative retinal vasculopathies received intracameral bevacizumab (1.25 mg). Ophthalmic evaluations included Snellen visual acuity (VA), complete ophthalmic iris angiography, and slit lamp photography. Main outcome measure was change in degree of iris neovascularization. Secondary outcomes included fluorescein iris angiographic leakage, control of intraocular pressure, and changes in VA. RESULTS: All patients with neovascularization demonstrated by slit lamp photography and fluorescein angiography (16/16 eyes) had complete (or at least partial) reduction in leakage of the neovascularization within 3 weeks after the injection. Leakage from iris neovascularization resolved in 12 of 16 (75%) eyes. In two cases recurrent leakage was seen as early as 4 weeks necessitating repeat injection. Intraocular pressure was controlled with maximum medical therapy in eight of nine eyes reducing the need for glaucoma surgery. Visual acuity improved from a median of hand motions to 20/200. CONCLUSIONS: In summary, intracameral bevacizumab was effective in reversing iris neovascularization in the majority of patients. It also facilitated intraocular pressure control in patients with associated glaucoma.     

Influence of seasonal sunlight intensity and iris color on the anti-VEGF therapy for neovascular age-related macular degeneration

Purpose

To investigate the influence of seasonal light intensity and patients'' iris color on the visual recovery after anti-vascular endothelial growth factor (VEGF) therapy with ranibizumab or bevacizumab for neovascular age-related macular degeneration (AMD).

Methods

The visual acuity of 555 eyes (529 patients) with neovascular AMD was evaluated after intravitreal injections of either ranibizumab or bevacizumab in respect to global radiation intensity and iris color.

Results

The functional results during anti-VEGF therapy revealed a seasonal oscillation with a negative correlation between visual recovery and global radiation intensity (R²=−0.756, P=0.004). Although the influence of the sunlight intensity on the visual recovery was significant after the first injection, this effect vanished within the continuous course of treatment. Regarding the improvement of functional recovery depending on iris color, dark-colored eyes (16.0%) gained 8.5±10.0 letters after the first injection and 9.9±12.8 letters after the second injection, compared with 3.4±8.6 letters and 4.4±11.0 letters in light-colored eyes (84.0%), respectively (P=0.005 and P=0.019).

Conclusions

Our results indicate that seasonal sunlight intensity and iris color might influence the visual recovery of neovascular AMD patients undergoing anti-VEGF therapy. Our findings may be used as suggestions to refine individual anti-VEGF therapy regimens, especially in patients with light-colored eyes.     

Inhibitory effects of bevacizumab on angiogenesis and corneal neovascularization

Background

To evaluate the inhibitory effects of bevacizumab (Avastin®) on angiogenesis using cultured human umbilical vein endothelial cells (HUVECs) in vitro and on corneal neovascularization by subconjunctival injection of bevacizumab in vivo.

Methods

After the HUVECs were exposed to different concentrations of bevacizumab stimulated with VEGF (10 ng/ml) for 2, 6, and 24 hours, cellular-activity-like proliferation, migration and tube formation were assessed. Subconjunctival injection of bevacizumab (2.5 mg/0.1 ml) was performed after corneal chemical burn injury. Then the cornea was evaluated by biomicroscopy, fluorescein angiography, and light microscopy.

Results

The inhibitory effects of bevacizumab on VEGF-induced HUVECs proliferation showed a dose-dependent response for 2 and 6 hours, but all groups were effectively inhibited regardless of the concentration of bevacizumab for 24 hours. The inhibitory effects of bevacizumab on the migration of VEGF-induced HUVECs showed a time- and dose-dependent response. The inhibitory effects of bevacizumab on VEGF-induced HUVECs tube formation showed a dose-dependent response only for 24 hours. On days 3 and 8 after the subconjunctival injection, bevacizumab-treated eyes showed less neovascular growth than BSS-treated eyes in biomicroscopic, fluorescein angiographic, and light microscopic findings in vivo.

Conclusions

Bevacizumab effectively inhibits angiogenesis and corneal neovascularization, and could be used as a inhibitor of corneal neovascularization in the future.

     

Intracameral bevacizumab for iris rubeosis

PURPOSE: To determine whether intracameral bevacizumab decreases vascular leakage from iris rubeosis in patients with neovascular glaucoma. DESIGN: Interventional case series. METHODS: The study included six eyes of three patients with secondary neovascular glaucoma due to proliferative diabetic retinopathy (n = 2) or ischemic central retinal vein occlusion (n = 1). All patients received an intracameral injection of 1.0 mg bevacizumab. Morphologic changes and vascular leakage were investigated prospectively by iris fluorescein angiography. RESULTS: Decrease in leakage was detected as early as one day after injection. No inflammation was observed. No relapse was seen within the follow-up of four weeks. CONCLUSION: Intraocular injection of bevacizumab may provide an additional strategy for the treatment of iris rubeosis in neovascular glaucoma.     

Neovascular Glaucoma Induced by Peripheral Retinal Ischemia in Neurofibromatosis Type 1: Management and Imaging Features

Purpose

To report the case of a young patient affected by neurofibromatosis 1 (NF-1) with peripheral retinal ischemia-induced neovascular glaucoma and the peculiar spectral-domain optical coherence tomography (SD-OCT) features.

Material and Methods

A 13-year-old boy affected by NF-1, as diagnosed according to established criteria, was referred with a diagnosis of hypertensive uveitis in his left eye. He underwent a complete ophthalmic examination and comprehensive blood work with viral and immunological tests. The case was documented with fluorescein angiography (FA) and SD-OCT. When the intraocular pressure (IOP) of the left eye decreased and the cornea cleared, FA revealed retinal ischemia and leakage from pathologic retinal vessels. SD-OCT revealed foveal hypoplasia secondary to the complete absence of the retinal nerve fiber layer.

Results

Peripheral retinal ischemia-induced neovascular glaucoma was diagnosed. The patient underwent Ahmed valve implantation to control his IOP, and subsequent retinal photocoagulation by argon laser and intravitreal bevacizumab injection were performed to control neovascularization.

Discussion

Retinal ischemia in NF-1 might lead to neovascular glaucoma: lowering of the IOP with surgical implantation of an Ahmed valve, regression of neovascularization by argon laser panretinal photocoagulation and intravitreal injection of bevacizumab can be a helpful way to control such a complication.Key words: Neovascular glaucoma, Neurofibromatosis, Retinal ischemia     

Bevacizumab in conjunction with panretinal photocoagulation for neovascular glaucoma

BackgroundNeovascular glaucoma (NVG) is a type of secondary angle-closure glaucoma that can result from severe retinal ischemia, such as proliferative diabetic retinopathy. Vascular endothelial growth factor (VEGF) plays a role in ocular neovascularization, which can result in NVG. The use of bevacizumab, an anti-VEGF antibody, has been shown to lead to the rapid resolution of ocular neovascularization and may be used off-label in conjunction with panretinal photocoagulation in the treatment of neovascular glaucoma.1, 2, 3, 4Case ReportA 71-year-old man presented with neovascular glaucoma in both eyes secondary to proliferative diabetic retinopathy and was treated with both panretinal photocoagulation and an intravitreal injection of bevacizumab, which led to the rapid resolution of his iris neovascularization. A follow-up examination after 12 months showed that there was no recurrence of neovascularization.ConclusionThis case shows the possible beneficial effects of bevacizumab in conjunction with panretinal photocoagulation as a treatment option for neovascular glaucoma.     

前部视网膜冷凝术对新生血管性青光眼患者房水中血管内皮生长因子含量的影响

目的 探讨前部视网膜冷凝术对新生血管性青光眼患者房水中血管内皮生长因子（VEGF）含量的影响以及VEGF含量的变化与虹膜新生血管之间的关系。方法对28例确诊为新生血管性青光眼患者行虹膜血管造影,确定新生血管的范围和数量后,行前部视网膜冷凝术,7～14d后经虹膜血管造影确定虹膜新生血管大部分消退后,再行小梁切除术。分别于前部视网膜冷凝术前和小梁切除术前抽取房水标本,另取30例老年性白内障患者房水标本。采用酶联免疫吸附法分别测定全部房水标本中的VEGF含量。结果小梁切除术前房水中VEGF的含量[（2．096±0．512）ng／ml]明显低于前视网膜冷凝术前房水中VEGF含量[（0．478±0．312）ng／ml],两者比较差异有统计学意义（P〈0．01）。小梁切除术前房水中VEGF含量明显高于老年性白内障患者房水中VEGF的含量[（0．198±0．045）ng／ml],两者比较差异有统计学意义（P〈0．01）。结论VEGF在虹膜新生血管的形成中可能发挥一定的作用;阻断促使虹膜产生新生血管的VEGF来源,可抑制新生血管性青光眼的发生.（中华眼科杂志．2007．43：622-625）     

Effect of intravitreal injection of bevacizumab-chitosan nanoparticles on retina of diabetic rats

AIM:To investigate the effects of intravitreal injection of bevacizumab-chitosan nanoparticles on pathological morphology of retina and the expression of vascular endothelial growth factor (VEGF) protein and VEGF mRNA in the retina of diabetic rats.METHODS: Seventy-two 3-month aged diabetic rats were randomly divided into 3 groups, each containing 24 animals and 48 eyes. Both eyes of the rats in group A were injected into the vitreous at the pars plana with 3μL of physiological saline, while in groups B and C were injected with 3μL (75μg) of bevacizumab and 3μL of bevacizumab-chitosan nanoparticles (containing 75μg of bevacizumab), respectively. Immunohistochemistry was used to assess retinal angiogenesis, real-time PCR assay was used to analyse the expression of VEGF mRNA, and light microscopy was used to evaluate the morphology of retinal capillaries.RESULTS:Real-time PCR assay revealed that the VEGF mRNA expression in the retina before injection was similar to 1 week after injection in group A (P>0.05), while theVEGF mRNA expression before injection significantly differed from those 4 and 8 weeks after injection (P<0.05). Retinal expression of VEGF protein and VEGF mRNA was inhibited 1 week and 4 weeks after injection (P<0.05) in group B, and the expression of VEGF protein and VEGF mRNA was obviously inhibited until 8 weeks after injection (P<0.05) in group C. Using multiple comparisons among group A, group B, and group C, the VEGF expression before injection was higher than at 1, 4 and 8 weeks after injection (P<0.05). The amount of VEGF expression was higher 8 weeks after injection than 1 week or 4 weeks after injection, and also higher 1 week after injection compared with 4 weeks after injection (P<0.05). No toxic effect on SD rats was observed with bevacizumab-chitosan nanoparticles injection alone.CONCLUSION: The results offer a new approach for inhibiting angiogenesis of diabetic retinopathy and indicate that the intravitreal injection of bevacizumab inhibits VEGF expression in retina, and bevacizumab-chitosan nanoparticles have a longer duration of action.     

Adverse events associated with intraocular injections of bevacizumab in eyes with neovascular glaucoma

Background  

Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor (VEGF), has been reported to cause rapid regression of anterior segment neovascularization in eyes with neovascular glaucoma when administered intraocularly. Several studies have reported the safety profile of intravitreal injections of bevacizumab in patients with various retinal pathologies. We investigated the occurrence of adverse events associated with intraocular bevacizumab injections in patients with neovascular glaucoma.     

Effects of Argon Laser Iridotomy on the Corneal Endothelium of Pigmented Rabbit Eyes

Purpose

In Asian countries, laser iridotomy for the treatment of angle-closure glaucoma is a common cause of bullous keratopathy, which may be associated with a shallow anterior chamber and dark iris pigmentation in Asians. Several cases of corneal decompensation after argon laser iridotomy have been reported. In the present study, we evaluated the harmful effects of argon laser iridotomy on the corneal endothelium.

Methods

Argon laser iridotomy was performed on the right eyes of pigmented rabbits. Changes in corneal thickness and endothelial cell density after laser iridotomy were evaluated. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) was performed for assessment of corneal endothelial cell apoptosis. Combined staining with alizarin red and trypan blue, as well as a live/dead cell assay, were performed for evaluation of damage to the corneal endothelium induced by laser iridotomy.

Results

Corneal thickness did not change immediately after laser iridotomy; however, a significant increase was observed 24 hours after iridotomy (p = 0.001). The endothelial cell density of laser-treated eyes four days after laser iridotomy was significantly decreased compared with control eyes (p < 0.001). TUNEL staining showed many TUNEL-positive cells in the corneal endothelium and corneal stroma. No endothelial trypan blue-stained cell nuclei were observed after laser iridotomy; however, several large endothelial cells with damaged membrane integrity were observed. The live/dead cell assay clearly showed a large number of dead cells stained red in several areas throughout the entire corneal button 24 hours after iridotomy.

Conclusions

Argon laser iridotomy induces corneal endothelial cell apoptosis in pigmented rabbit eyes, resulting in decreased endothelial cell density.     

Serum Concentration of Vascular Endothelial Growth Factor after Bilateral Intravitreal Injection of Bevacizumab

Purpose

This study compared serum vascular endothelial growth factor (VEGF) concentration between patients given the bilateral and unilateral intravitreal injections of bevacizumab.

Methods

In a prospective manner, serum VEGF levels in treatment-naive patients with age-related macular degeneration who underwent bilateral or unilateral intravitreal injections of bevacizumab were investigated. After informed consent, peripheral blood was collected from in patients who underwent bilateral or unilateral intravitreal injection of bevacizumab before and 1 month after the injection. Serum VEGF levels were measured by enzyme-linked immunosorbent assay after centrifugation. In addition, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) before and 1 month after the injection were compared between each group.

Results

Twenty patients received bilateral injections (40 eyes) and 20 patients received unilateral injections. The VEGF concentrations (pg/mL) before the bilateral injection were 235.75 ± 183.16 and 252.53 ± 233.52 for the unilateral injection. They were significantly reduced to 153.88 ± 113.26 and 189.42 ± 251.72 after 1 month, respectively (p = 0.037 and 0.019), which are showing no significant difference between the two groups (p = 0.771). And there were no significant intergroup difference in pre- and postoperative BCVA and CRT.

Conclusions

The bilateral simultaneous intravitreal injection of bevacizumab did not differ greatly from unilateral intravitreal injection in the influence on serum VEGF levels and the therapeutic outcome.     

Inhibitory effect of polysulfated heparin endostatin onalkali burn induced corneal neovascularization in rabbits

AIM: To investigate anti-angiogenic effects of polysulfated heparin endostatin (PSH-ES) on alkali burn induced corneal neovascularization (NV) in rabbits. METHODS: An alkali burn was made on rabbit corneas to induce corneal NV in the right eye of 24 rabbits. One day after burn creation, a 0.2 mL subconjunctival injection of 50 μg/mL PSH-ES, 50 μg/mL recombinant endostatin (ES), or normal saline was administered every other day for a total of 14d (7 injections). Histology and immunohistochemisty were used to examine corneas. Corneal NV growth was evaluated as microvessel quantity and corneal vascular endothelial growth factor (VEGF) expression was measured by immunohistochemical assay. RESULTS: Subconjunctival injection of ES and PSH-ES resulted in significant corneal NV suppression, but PSH-ES had a more powerful anti-angiogenic effect than ES. Mean VEGF concentration in PSH-ES treated corneas was significantly lower than in ES treated and saline treated corneas. Histological examination showed that corneas treated with either PSH-ES or ES had significantly fewer microvessels than eyes treated with saline. Additionally corneas treated with PSH-ES had significantly fewer microvessels than corneas treated with ES. CONCLUSION: Both PSH-ES and recombinant ES effectively inhibit corneal NV induced by alkali burn. However, PSH-ES is a more powerful anti-angiogenic agent than ES. This research has the potential to provide a new treatment option for preventing and treating corneal NV.     

Bevacizumab联合Ex-press引流管治疗新生血管性青光眼

目的:探讨玻璃体腔注射贝伐单抗(bevacizumab)联合Ex-press青光眼引流管植入术治疗新生血管性青光眼的疗效和安全性。方法:对18例19眼新生血管性青光眼患者,先行玻璃体腔注射bevacizumab,待虹膜新生血管消退或萎缩后,再行Ex-press青光眼引流管(P-200)植入术,其中6例6眼联合超声乳化白内障吸除术。根据患者屈光介质情况术前或术后尽量行全视网膜光凝。Ex-press植入术后随访12mo,观察视力、眼压和手术并发症情况。结果:玻璃体腔注药后2~7d,16眼新生血管全部消退。术后平均眼压:1mo:13.05±2.46mmHg,3mo:13.80±1.88mmHg,6mo:14.30±1.38mmHg;12mo:14.60±1.43mmHg,术后1,3,6,12mo眼压与术前相比均有显著性差异(P<0.05),且术后1,3,6,12mo眼压相比均无显著性差异(P>0.05)。19眼术后视力有提高者4眼,无明显改变15眼,无视力下降眼,完全成功11眼(58%),部分成功5眼(26%),总手术成功率84%(16/19)。术后并发症:有2例术后早期短暂浅前房,散瞳1wk后前房恢复正常,1例前房少量积血,无排斥反应和严重并发症。结论:玻璃体腔注射bevacizumab可使新生血管青光眼虹膜新生血管迅速消退或萎缩,为下一步青光眼手术创造良好的条件。Ex-press青光眼引流管植入术是新的滤过性手术,该手术创伤小,不用切除虹膜,减少了术中、术后出血的风险,联合bevacizumab是治疗新生血管性青光眼的安全而有效的术式。     

贝伐单抗兔眼前房注射后在眼组织的分布及其不良反应的研究

背景贝伐单抗已被广泛用于眼部新生血管性疾病的治疗,对眼前房注射后其药代动力学改变和安全性评价可为其治疗虹膜新生血管和新生血管性青光眼提供依据。目的观察前房注射贝伐单抗后药物在兔眼组织的分布并评价其安全性。方法20只健康新西兰白兔按随机数字表法分为2组,实验组左眼前房注射0．05ml贝伐单抗（1．25mg）,对照组左眼前房注射平衡盐溶液0．05ml。注射药物前后用裂隙灯及直接检眼镜检查眼前段和眼底表现并定期监测眼压、行角膜内皮镜检查并评估角膜内皮细胞计数的动态变化。前房注射后1、4、7、14、30d光学显微镜下行兔视网膜的组织病理学检查,注射后第4天和第30天透射电子显微镜下行兔视网膜的超微结构检查,应用免疫荧光染色法检测前房注射后不同时间贝伐单抗在眼组织中的分布情况。结果贝伐单抗前房注射后裂隙灯及直接检眼镜检查显示实验眼前后节组织和视网膜未见异常表现,实验组注药前后的眼压、角膜内皮细胞密度与对照组比较差异均无统计学意义（P=0．760,P=0．956）。眼组织病理学检查提示,实验组与对照组注药后角膜、晶状体、前房角、虹膜、睫状体、视网膜结构均未见异常改变;透射电子显微镜下实验组和对照组注药后角膜、晶状体、虹膜、睫状体超微结构无明显改变。免疫荧光染色显示,贝伐单抗前房注射后,注射眼和对侧眼的前房角、虹膜、睫状体、脉络膜和视网膜上均有红色荧光,对侧眼较注射眼荧光染色弱,红色荧光主要集中于血管壁和血管腔。贝伐单抗前房注射后第1天到第4天虹膜荧光染色最强,随后逐渐衰减,第30天仍有较弱的染色,注射后第7天睫状体染色较虹膜强,随后逐渐衰减,第30天仍有较弱的染色;注射后眼前房角染色最强的现象见于第4天到第7天,随后逐渐衰减,第30天消失。结论前房注射贝伐单抗1．25mg对正常兔眼组织无明显的毒性作用和不良反应,注射后药物能快速分布于注射眼的前房角、虹膜、睫状体、脉络膜和视网膜,主要堆积在血管样组织中。     

Multifocal electroretinogram findings after intravitreal bevacizumab injection in choroidal neovascularization of age-related macular degeneration

Purpose

To evaluate the changes in multifocal electroretinogram (mfERG) and optical coherence tomography (OCT) after intravitreal bevacizumab injection in the treatment of age-related macular degeneration (AMD).

Methods

Twenty-one eyes with choroidal neovascularization secondary to AMD were studied before and after intravitreal bevacizumab injection for best corrected visual acuity (BCVA), OCT, and mfERG.

Results

The BCVA improved, while central macular thickness and total macular volume in OCT decreased after intravitreal bevacizumab injection (p = 0.03, 0.01, and 0.01, respectively). In mfERG, the amplitude of P1, and implicit time of P1 and N1 indicated a statistically significant improvement of retinal response after intravitreal bevacizumab injection.

Conclusions

There is a potential role for mfERG in evaluating the effect on retinal function of intravitreal bevacizumab injection.     

Choroidal Neovascularization Regression on Fluorescein Angiography after VEGF Blockade

Background

Intravitreal vascular endothelial growth factor (VEGF) inhibitors stabilize vision in a majority of patients with neovascular age-related macular degeneration (AMD) and can improve vision in almost 40% of patients. However, some individuals who respond to anti-VEGF treatment still lose vision due to the formation of geographic atrophy (GA). While optical coherence tomography is often the primary imaging modality used, fluorescein angiography (FA) can provide useful information on GA development after choroidal neovascularization (CNV) regression.

Methods

A retrospective chart review was conducted to evaluate the changes seen on FA over a 47-month period for 3 patients with neovascular AMD treated with anti-VEGF inhibitors.

Results

All 3 patients were initially noted to have subfoveal CNV due to AMD at baseline; they were followed up monthly and treated on an as needed basis for at least 47 months with intravitreal VEGF inhibitors. All subjects had regression of their CNV lesions after VEGF blockade. Two subjects developed foveal atrophy.

Conclusions

This case series depicts the changes on FA seen over a 4-year period and shows that GA can occur with regression of CNV after treatment with VEGF inhibitors.Key words: Choroidal neovascularization, Fluorescein angiography, Age-related maculopathies     

EX-PRESS引流钉植入术联合康柏西普及PRP治疗新生血管性青光眼

目的：评价EX-PRESS房水引流钉植入术联合玻璃体内注射康柏西普及全视网膜光凝(PRP)治疗新生血管性青光眼的临床疗效。

方法：回顾性分析2015-01/2018-05在我院符合纳入标准的新生血管性青光眼患者21例21眼，术前均先行康柏西普玻璃体内注射，5～10d虹膜新生血管消退后接受EX-PRESS房水引流钉植入术，2～3wk后行全视网膜光凝术，术后随访12mo观察眼压、视力、虹膜新生血管复发率、术后并发症情况。

结果：患者引流钉植入术前术后不同时间眼压比较，差异有统计学意义(F=18.513， P<0.05)。引流钉植入术前和术后视力比较，差异有统计学意义(P=0.008)。至末次随访时，手术完全成功18眼(86%)，条件成功2眼(9%)，总手术成功率95%。虹膜新生血管复发1眼(5%)，术后浅前房1眼(5%)、高眼压5眼(24%)。

结论：康柏西普注射玻璃体后行EX-PRESS房水引流钉植入术再联合PRP可有效降低新生血管性青光眼的眼压。     

Aflibercept Treatment for Neovascular Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy Refractory to Anti-vascular Endothelial Growth Factor

Purpose

To report the results of switching treatment to vascular endothelial growth factor (VEGF) Trap-Eye (aflibercept) in neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) refractory to anti-VEGF (ranibizumab and bevacizumab).

Methods

This is a retrospective study involving 32 eyes from 29 patients; 18 were cases of neovascular AMD and 14 were cases of PCV. The best-corrected visual acuity (BCVA) and central macular thickness (CMT) of spectral-domain optical coherence tomography were evaluated.

Results

BCVA and CMT improved from 0.58 to 0.55 (p = 0.005) and from 404 to 321 µm (p < 0.001), respectively, after switching to aflibercept. The 14 eyes that received 6 or more aflibercept injections remained stable at 0.81 to 0.81 and 321 to 327 µm (p = 1.0, 0.29), respectively, after 3 aflibercept injections. The 10 eyes that received 3 or more bevacizumab injections after 3 or more aflibercept injections worsened, from 0.44 to 0.47 and from 332 to 346 µm (p = 0.06, 0.05), respectively. The results showed similar improvement of BCVA and CMT in neovascular AMD and PCV.

Conclusions

Aflibercept seems to be effective for improvement and maintenance of BCVA and CMT for neovascular AMD and PCV refractory to anti-VEGF. Switching from aflibercept back to bevacizumab treatment may not be a proper strategy.