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Judicious use of anti-VEGF agents advised as 'reasonable'
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 Elias Reichel |
PHILADELPHIA — The judicious use of anti-VEGF agents for the treatment of age-related macular degeneration is reasonable, considering the biological and clinical responses, a speaker said here.
Anti-VEGF injections can be associated with elevated IOP, tachyphylaxis and reduced ocular perfusion, Elias Reichel, MD, said at Macula 2011, adding that these cautionary observations should be kept in mind.
Furthermore, he said, there are exceptions to what might be expected when considering anti-VEGF treatment.
"There are case exceptions. We have patients that masquerade as possible wet AMD, cases that are robust responders, cases that we would think they are poor responders, but they actually respond very well," Dr. Reichel said.
Research has shown that there is a potential for sustained elevated IOP after single or multiple injections of anti-VEGF agents, Dr. Reichel explained.
"This is important to understand that some patients may respond early to anti-VEGF agents, but then they may not respond over time," Dr. Reichel said.
He said cautionary observations included a significantly reduced ocular perfusion pressure at time of injection. There was a significant reduction in ocular perfusion pressure immediately after injection in about 40% of patients.
"This is not just purely a volumetric response. There are direct effects of the drug," Dr. Reichel said.
Additionally, he noted that 8% to 10% of patients had ocular perfusion pressure decreased to zero, when such pressure would normally be approximately 30 mm Hg.
- Disclosure: Dr. Reichel has disclosed financial interests in Akorn, Alimera, Allergan, Biogen Idec, Eyetech, Falck Medical, GlaxoSmithKline, Genetech, NeoVista, Ocular Instruments and Ophthotech.