Double-Dose Ranibizumab for Eyes with Refractory Exudative Age-Related Macular Degeneration 

Authors

  • Bobeck S. Modjtahedi From the Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, CA, USA
  • Lawrence S. Morse From the Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, CA, USA
  • Saadia Rashid From the Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, CA, USA
  • Susanna S. Park From the Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, CA, USA

DOI:

https://doi.org/10.12974/2309-6136.2013.01.01.5

Keywords:

Age related macular degeneration, pharmacology, ranibizumab, retina, tachyphylaxis, tolerance, non-responder.

Abstract

In this retrospective chart review of the 10 eyes (8 subjects) with exudative age-related macular degeneration that had persistent macular fluid on spectral-domain optical coherence tomography (SD-OCT) [after at least 3 monthly intravitreal ranibizumab (0.5mg) or bevacizumab (1.25mg)], central macular thickness was significantly lower after 2 monthly double-dose intravitreal ranibizumab injections (0.1mg, DDR) (324 + 77µm at baseline vs 248 + 50µm, P=0.02).

Seven of 10 eyes that received DDR had some qualitative anatomic improvement on SD-OCT with the first 2 DDR, but no further OCT improvements were noted thereafter with additional DDR. The DDR treatment effect was transient in 3 of 7 eyes despite sustained DDR treatment.

Best corrected visual acuity remained stable in 7 of 10 eyes over the initial period of DDR (first 2-3 injections), 2 eyes improved > 2 lines and 1 eye had > 2 lines of worsening. The improvement in BCVA did not correlate with improvement noted on SD-OCT.

Paracentesis was performed frequently for acute intraocular pressure elevation or as prophylaxis in eyes receiving DDR due to the higher volume injected intravitreally but no other ocular or systemic adverse effect was noted with DDR. 

References

Rosenfeld PJ, Brown DM, Heier JS, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006; 355(14): 1419-31. http://dx.doi.org/10.1056/NEJMoa054481

Eghoj MS, Sorensen TL. Tachyphylaxis during treatment of exudative age-related macular degeneration with ranibizumab. Br J Ophthalmol 2012; 96(1): 21-3. http://dx.doi.org/10.1136/bjo.2011.203893

Forooghian F, Cukras C, Meyerle CB, Chew EY, Wong WT. Tachyphylaxis after intravitreal bevacizumab for exudative age-related macular degeneration. Retina 2009; 29(6): 723-31. http://dx.doi.org/10.1097/IAE.0b013e3181a2c1c3

Binder S. Loss of reactivity in intravitreal anti-VEGF therapy: tachyphylaxis or tolerance? Br J Ophthalmol 2012; 96(1): 1-2. http://dx.doi.org/10.1136/bjophthalmol-2011-301236

Arjamaa O, Minn H. Resistance, not tachyphylaxis or tolerance. Br J Ophthalmol 2012; Epub 2012/04/19.

Tao Y, Jonas JB. Intravitreal bevacizumab combined with intravitreal triamcinolone for therapy-resistant exudative agerelated macular degeneration. J Ocul Pharmacol Ther 2010; 26(2): 207-12. http://dx.doi.org/10.1089/jop.2009.0131

Modarres M, Naseripour M, Falavarjani KG, Nikeghbali A, Hashemi M, Parvaresh MM. Intravitreal injection of 2.5 mg versus 1.25 mg bevacizumab (Avastin) for treatment of CNV associated with AMD. Retina 2009; 29(3): 319-24. http://dx.doi.org/10.1097/IAE.0b013e318198148e

Rosenfeld PJ, Heier JS, Hantsbarger G, Shams N. Tolerability and efficacy of multiple escalating doses of ranibizumab (Lucentis) for neovascular age-related macular degeneration. Ophthalmology 2006; 113(4): 623 e1.

Cho H, Shah CP, Weber M, Heier JS. Aflibercept for exudative AMD with persistent fluid on ranibizumab and/or bevacizumab. Br J Ophthalmol 2013; Epub 2013/06/15.

Brown DM, Chen E, Mariani A, Major JC, Jr. Super-dose anti-VEGF (SAVE) trial: 2.0 mg intravitreal ranibizumab for recalcitrant neovascular macular degeneration-primary end point. Ophthalmology 2013; 120(2): 349-54. http://dx.doi.org/10.1016/j.ophtha.2012.08.008

Mojica G, Hariprasad SM, Jager RD, Mieler WF. Short-term intraocular pressure trends following intravitreal injections of ranibizumab (Lucentis) for the treatment of wet age-related macular degeneration. Br J Ophthalmol 2008; 92(4): 584. Epub 2008/03/29.

Sharei V, Hohn F, Kohler T, Hattenbach LO, Mirshahi A. Course of intraocular pressure after intravitreal injection of 0.05 mL ranibizumab (Lucentis). Eur J Ophthalmol 2010; 20(1): 174-9.

Falkenstein IA, Cheng L, Freeman WR. Changes of intraocular pressure after intravitreal injection of bevacizumab (avastin). Retina 2007; 27(8): 1044-7. http://dx.doi.org/10.1097/IAE.0b013e3180592ba6

Choi DY, Ortube MC, McCannel CA, et al. Sustained elevated intraocular pressures after intravitreal injection of bevacizumab, ranibizumab, and pegaptanib. Retina 2011; 31(6): 1028-35. http://dx.doi.org/10.1097/IAE.0b013e318217ffde

Kotliar K, Maier M, Bauer S, Feucht N, Lohmann C, Lanzl I. Effect of intravitreal injections and volume changes on intraocular pressure: clinical results and biomechanical model. Acta Ophthalmol Scand 2007; 85(7): 777-81. http://dx.doi.org/10.1111/j.1600-0420.2007.00939.x

Silver DM, Geyer O. Pressure-volume relation for the living human eye. Curr Eye Res 2000; 20 (2): 115-20. http://dx.doi.org/10.1076/0271-3683(200002)2021-DFT115

Dastiridou AI, Ginis HS, De Brouwere D, et al. Ocular rigidity, ocular pulse amplitude, and pulsatile ocular blood flow: the effect of intraocular pressure. Invest Ophthalmol Vis Sci 2009; 50(12): 5718-22. http://dx.doi.org/10.1167/iovs.09-3760

Downloads

Published

2013-04-04

How to Cite

Modjtahedi, B. S., Morse, L. S., Rashid, S., & Park, S. S. (2013). Double-Dose Ranibizumab for Eyes with Refractory Exudative Age-Related Macular Degeneration . Journal of Ocular Diseases and Therapeutics, 1(1), 18–23. https://doi.org/10.12974/2309-6136.2013.01.01.5

Issue

Section

Articles