Algorithm of managing patients with exudative form of age-related macular degeneration with resistance to one of the anti-VEGF drugs

Abstract

The exudative form of AMD can develop suddenly, leading within a few weeks or months to the death of photoreceptors, a sharp decrease in BCVA and persistent central scotoma. Despite significant progress in the treatment of neovascular AMD associated with the introduction of anti-VEGF drugs into clinical practice, a number of patients have an insufficient response or its absence with standard administration regimens, and sometimes a decrease in the therapeutic effect after repeated intravitreal injections [1, 2]. Purpose. To development management tactics for patients resistant to one of the anti-VEGF drugs. Material and мethod. This study included 25 patients with a diagnosis of exudative AMD who received Aflibercept in the treat & extend regimen for a year, without a significant effect (persistence of intraretinal, subretinal and/or fluid under RP). Patients were switched to brolucizumab. The mean maximum correctable visual acuity in patients treated with aflibercept before switching drugs was 0.41 ± 0.11. The mean number of injections during the first year in the aflibercept group was 7.1 and 6.8 after switching to brolucizumab. The maximum correctable visual acuity at the end of 1 year of treatment with brolucizumab was 0.47 ± 0.1. Before the start of treatment with aflibercept, the mean CRT was 435.2 ± 119.8, at the end of the first year of treatment 403.3 ± 115.9, before 1 intravitreal injection of brolucizumab 407.2 ± 119.3 and 1 year after the start of therapy 357.6 ± 111.4 (p = 0.042). A statistical difference was found between the preparations and the height of the detachment of the retinal pigment epithelium at the end of the first year of treatment. Changes in the height of detachment of the retinal pigment epithelium in 3 eyes (12 %) were not observed when changing the drug. A positive response to drug switching should be noted, although it cannot be overlooked that there are patients who are resistant to anti-VEGF therapy per se. Keywords: the exudative form of AMD, anti-VEGF drugs, neovascular AMD.