Response to long acting anti VEGF in case of CNV associated with AMD
Dr. Shashank Somani, Dr. Sarang Lambat, Dr. Prabhat Nangia, Dr. Vinay Nangia
Suraj Eye Institute, 559, New Colony, Sadar, Nagpur- 440001.
A male, 71 years of age, came with complaints of black spot in front of left eye since 8 days which was sudden in onset and increased with time. He was a known case of systemic hypertension since 10 years. His best corrected visual acuity was 6/6, N6 in right eye and 6/18, N18 in left eye. Anterior segment examination showed presence of early cataractous lens changes in both the eyes. Intraocular pressure recorded by Goldmann applanation tonometer was 12 mmHg in both eyes.
Based on the clinical findings, a diagnosis of choroidal neovascular membrane with age related macular degeneration was made and the patient was advised intravitreal anti-VEGF injection for the left eye. The patient was followed up on 1 month after each injection and sequential OCT line scans were taken on each followup.
An option of a long acting anti VEGF was discussed with the patient with an aim to reduce the number of injections and follow up visits. Patient was advised inj Brolucizumab which was done on 17/09/2021.
This is a typical case of AMD who required multiple injections of anti-VEGF. The patient used to respond to the monthly injections but the edema used to recur again at the end of a month. The management of such a situation includes switching to a treat and extend regime or plan for a long acting anti-VEGF injection. We discussed the options with the patient and he was willing to go for the long acting anti-VEGF – Brolucizumab. The patient was informed about the possible side effects that may on occasion be associated with the use of Intravitreal Brolucizumab. The response to Brolucizumab was quite satisfactory as the edema got completely resolved and patient did not require an injection even at the end of 2 months at the last follow up.
Repeated follow ups in cases of AMD and non availability of an escort apart from the pain and difficulties associated with monthly injections has been a significant challenge in treatment of the elderly population. This is known to cause treatment drop outs and delay in treatment which could have a significant impact on vision. Long acting anti-VEGFs are a plausible options in such a scenario and with the availability of these newer molecules take us closer to the goal of greater efficacy and duration of action.
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Dr. Sarang Lambat
Suraj Eye Institute
Email – email@example.com