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Graefe's Archive for Clinical and Experimental Ophthalmology

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01-11-2019 | Photodynamic Therapy | Medical Ophthalmology

Tachyphylaxis during treatment of exudative age-related macular degeneration with aflibercept

Authors: Chikako Hara, Taku Wakabayashi, Yoko Fukushima, Kaori Sayanagi, Ryo Kawasaki, Shigeru Sato, Hirokazu Sakaguchi, Kohji Nishida

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 11/2019

Abstract

Purpose

At present, the standard treatment of neovascular age-related macular degeneration (AMD) is the repeated administration of antivascular endothelial growth factor (VEGF) agents. However, we often encounter patients who develop tachyphylaxis for anti-VEGF agents. In this study, we investigated the characteristics of patients who developed tachyphylaxis on repeated intravitreal aflibercept (IVA) injections for neovascular AMD and the frequency of tachyphylaxis.

Methods

Three hundred thirteen eyes (313 patients) with treatment-naïve AMD who achieved resolution soon after starting IVA and were followed up for ≥ 12 months were enrolled in this retrospective, interventional, consecutive case series. The eyes were investigated for tachyphylaxis to aflibercept. Tachyphylaxis was defined as absence of any improvement (more than 100 μm) in or worsening of CRT within 1 month after more than two repeated monthly IVA injections when the exudative change remained.

Results

Twenty-eight (8.9%) of the 313 eyes developed tachyphylaxis (occult with no classic, n = 14; polypoidal choroidal vasculopathy, n = 14) at an annual rate of about 3%. The mean number of IVA injections was 10.5 ± 7.8, and the mean interval until tachyphylaxis was 20.9 ± 14.0 months. There was a significant difference in the AMD subtypes between the group with tachyphylaxis and the group without it (p = 0.0029). Occult with no classic type and polypoidal choroidal vasculopathy were the only AMD subtypes in the eyes with tachyphylaxis. In the analysis of the eyes that had occult with no classic or polypoidal choroidal vasculopathy, only intraretinal edema was significantly less common (p = 0.042). A combination of photodynamic therapy and aflibercept was effective in 13 (87%) of 15 eyes with tachyphylaxis, and switching to intravitreal ranibizumab was effective in 5 (56%) of 9 eyes.

Conclusions

Tachyphylaxis occurs after repeated IVA injections in a minority of patients with AMD for a long term and is more likely to occur in eyes with lesions beneath the retinal pigment epithelium and no intraretinal edema. Treatment of AMD should be performed keeping this fact in mind, while considering the consecutive treatment.

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Title: Tachyphylaxis during treatment of exudative age-related macular degeneration with aflibercept
Authors: Chikako Hara
Taku Wakabayashi
Yoko Fukushima
Kaori Sayanagi
Ryo Kawasaki
Shigeru Sato
Hirokazu Sakaguchi
Kohji Nishida
Publication date: 01-11-2019
Publisher: Springer Berlin Heidelberg
Keywords: Photodynamic Therapy
Macular Degeneration
Aflibercept
Ranibizumab
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 11/2019
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-019-04456-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Tachyphylaxis during treatment of exudative age-related macular degeneration with aflibercept

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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