Features of AMD treatment non-responders
Reviewed by Jonathan Chan

This is a retrospective consecutive case series of 365 eyes with age-related macular degeneration (AMD) who had three monthly intravitreal aflibercept treatments for at least 12 months. Responders were defined as complete resolution of exudation, intraretinal oedema, subretinal fluid, pigment epithelial detachment or >100um decrease of central retinal thickness (CRT) at three months comparing to baseline. Non-responders were defined as patients showing an increase in exudation or a decreased CRT of <100um; 19/365 eyes (5.2%) were non-responders. They were associated with choroidal vascular hyperpermeability on indocyanine green (ICG) angiogram and lower frequency of subretinal hypereflective materials on OCT imaging. In addition, this group of patients had a thicker central choroidal thickness (CCT) at baseline and after three monthly injections but not statistically significant. They also reported that additional intravitreal ranibizumab or PDT in combination with aflibercept were effective in 15/19 (79%) of the non-responder group. The authors concluded that aflibercept is effective in over 90% of the treatment naive AMD patients and identified that the non-responsiveness is associated with choroidal hyperpermeability in their series.

Characteristics of patients with neovascular age-related macular degeneration (AMD) who are non-responders to intravitreal aflibercept.
Hara C, Wakabayashi T, Toyama H, et al.
BRITISH JOURNAL OF OPHTHALMOLOGY
2019;103:623-9.