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Surgery should be considered for anti-VEGF non-responders
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BASSANO DEL GRAPPA, Italy — When patients with age-related macular degeneration do not respond to anti-VEGF therapy, even after switching to a second drug, they should be promptly referred to a vitreoretinal surgeon to evaluate potential surgical options, according to one specialist.
“Persisting with a pharmacological therapy that doesn’t work could rapidly lead to irreversible photoreceptor damage and hinder the possibility to successfully manage these patients surgically,” Ezio Cappello, MD, said at the Bassano Ophthalmology Meeting.
Ezio Cappello
Although no consensus exists among retina specialists on the definition of a “non-responder,” Cappello personally considers vision loss and no improvement or worsening of the anatomic conditions after the first loading phase as criteria for switching to an alternative drug.
“A certain degree of vision loss in presence of anatomical improvement is not a reason to classify patients as non-responders,” he said.
If the second pharmacological option shows to be ineffective after the first three monthly injections, combination therapy might be attempted in some cases. However, if this option also fails, surgery should be considered in eligible patients.
“It takes some courage to defer patients to surgery, particularly if they still have 20/60 to 20/50 vision, but there is a point when we must be able to step back and hand over the baton to the surgeon,” Cappello said.
Disclosure: Cappello reports no relevant financial disclosures.