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

Sung Woo Cho; Jeong Hun Bae; Su Jeong Song

doi:10.3341/jkos.2010.51.11.1464

Journal List > J Korean Ophthalmol Soc > v.51(11) > 1008684

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Cho, Bae, and Song: Anatomical Non-Responder to Intravitreal Bevacizumab for Neovascular Age-Related Macular Degeneration

Original Article

J Korean Ophthalmol Soc 2010;51(11):1464-1470.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.11.1464

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

Sung Woo Cho, MD, Jeong Hun Bae, MD, Su Jeong Song, MD

Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Su Jeong Song, MD Department of Ophthalmology, Kangbuk Samsung Hospital #108 Pyeong-dong, Jongno-gu, Seoul 110-746, Korea Tel: 82-2-2001-2257, Fax: 82-2-2001-2262, E-mail: eye-su@hanmail.net

Received 24 May 2010 Accepted 7 September 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Age-related macular degeneration (AMD), Avastin, Bevacizumab, Non-responder

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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.

Table 1.

Comparison of clinical and posterior retinal characteristics between responder and non-responder (Mean±SD)

Variable	Responder (n=38)	Non-responder (n=6)	P value^*
Age (yrs)	71.89 ± 8.06	75.17 ± 3.66	0.237
Gender (M:F)	25: 13	3: 3	0.652
Duration of F/U (mon)	13.66 ± 11.37	16.17 ± 8.66	0.244
OD: OS	14: 24	3: 3	0.662
Initial visual acuity	0.27 ± 0.21	0.30 ± 0.23	0.744
IOP^† (mmHg)	13.79 ± 3.35	14.67 ± 2.94	0.514
SE^‡ (D)	0.38 ± 1.43	−0.04 ± 1.58	0.595
Number of injection	2.26 ± 1.57	3.33 ± 1.63	0.081
CNV^§ lesion size (μ m)	4668.37 ± 1990.80	4613.50 ± 2064.80	0.507
Foveal thickness (μ m)	272.44 ± 103.31	254.00 ± 167.34	0.328
Macular volume (mm³)	7.27 ± 1.01	7.87 ± 3.56	0.286
Presence of SRD^∏ (No:Yes)	16: 22	4: 2	0.139
SRD height (μ m)	160.82 ± 112.14	336.36	0.180
CNV lesion type (Predominantly classic: Occult)	17: 21	1: 5	0.375
Presence of PED^# (No:Yes)	5: 33	1: 5	0.609
PED size (mm²)	1.51 ± 2.33	4.42 ± 1.56	0.001
Presence of SMH^@ (No:Yes)	20: 18	2: 4	0.664

^* Fisher's exact test, Mann-Whitney U test.

^† IOP = intraocular pressure

^‡ SE = spherical equivalent

^§ CNV = Choroidal neovascularization

^∏ SRD = Serous retinal detachment

^# PED = Pigment epithelial detachment

^@ SMH = Submacular hemorrhage.

Table 2.

Comparison of visual acuity, foveal thickness, macular volume between at baseline and at six months after treatment in each group (Mean ± SD).

	Responder (n=38)			Non-responder (n=6)
	Baseline	At 6 mon	P value^*	Baseline	At 6 mon	P value^†
Visual acuity	0.27 ± 0.21	0.39 ± 0.27	<0.001	0.30 ± 0.23	0.22 ± 0.23	0.109
Foveal thickness (μ m)	272.44 ± 103.31	194.19 ± 65.00	0.010	254.00 ± 167.34	337.80 ± 216.31	0.080
Macular volume (mm³)	7.27 ± 1.01	6.41 ± 0.65	0.002	7.87 ± 3.56	8.22 ± 3.50	0.080

^* Paired t-test

^† Wilcoxon signed-rank test.

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