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Observation |

Growth of Type 1 Neovascularization Following Cessation of Anti–Vascular Endothelial Growth Factor Therapy as a Possible Explanation for Treatment Resistance

Vinnie P. Shah, MD1,2; K. Bailey Freund, MD1,2
[+] Author Affiliations
1Vitreous-Retina-Macula Consultants of New York, New York, New York
2Department of Ophthalmology, New York University School of Medicine, New York, New York
JAMA Ophthalmol. 2013;131(7):967-969. doi:10.1001/jamaophthalmol.2013.2120.
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Extract

Intravitreal anti–vascular endothelial growth factor (anti-VEGF) therapy is currently the standard of care for the treatment of neovascular age-related macular degeneration. Herein, we describe a mechanism by which some patients who initially show a robust response to treatment may later in their course become refractory to this therapy.

Article InformationCorresponding Author: K. Bailey Freund, MD, Vitreous-Retina-Macula Consultants of New York, 460 Park Ave, 5th Floor, New York, NY 10022 (kbfny@aol.com)

Author Contributions:Study concept and design: Freund.

Acquisition of data: All authors.

Analysis and interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Freund.

Administrative, technical, and material support: Shah.

Conflict of Interest Disclosures: Dr Freund receives research support from Genentech and is a consultant for Genentech and Regeneron.

Funding/Support: This work was supported in part by the Macula Foundation, Inc.

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Figure 1.
Left Eye of an 86-Year-Old Woman With Neovascular Age-Related Macular Degeneration

A, Color photograph at presentation, prior to initiation of anti–vascular endothelial growth factor (VEGF) therapy. Arrow indicates scan line for optical coherence tomography images in B-E. B, Optical coherence tomography image prior to treatment with anti-VEGF agents. C, Optical coherence tomography image after 4 monthly intravitreal ranibizumab injections, showing consolidation of type 1 neovascular tissue (arrow). At this time, the patient was switched to optical coherence tomography–guided therapy. D, Optical coherence tomography image after 11 months without treatment, showing recurrent subretinal fluid and growth of neovascular tissue (arrow). E, Persistent subretinal fluid despite the reintroduction of anti-VEGF therapy.

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Figure 2.
Left Eye of an 87-Year-Old Man With Neovascular Age-Related Macular Degeneration

A, Color photograph at presentation, prior to initiation of anti–vascular endothelial growth factor (VEGF) therapy. Arrow indicates scan line for optical coherence tomography images in B-E. B, Optical coherence tomography image prior to treatment with anti-VEGF agents. C, Optical coherence tomography image after 15 intravitreal ranibizumab injections, showing consolidation of type 1 neovascular tissue (arrow). At this time, the patient was switched to optical coherence tomography–guided therapy. D, Optical coherence tomography image after 27 months without treatment, showing recurrent subretinal fluid and growth of neovascular tissue (arrow). E, Persistent subretinal fluid despite the reintroduction of anti-VEGF therapy.

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