Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Anti vegf switch-DR AJAY I DUDANI-MUMBAI RETINA CENTRE
1. SWITCH IN TIME SAVES NINE
AJAY I DUDANI
MUMBAI RETINA CENTRE
2. Case Presentation
• 84 yr old physician
• Hypertensive ,CABG done
• One eyed
• LE lost in 2001 : preVEGF era DUE TO RAP
• RE :RAP LESION 2005
• 31 LUCENTIS PRN(3-4 monthly)
• EYLEA SWITCH IN SEPT 2014
• SECOND DOSE IN JAN2015> DRY TILL DATE 6/6N6
• STRONG FAMILY HISTORY
8. WHY DID WE SWITCH
• POST 27 LUCENTIS OVER 2005 TO 2014
• TACHYPHYLAXIS
• FREQUENCY OF INJECTION REDUCED TO 2
MONTHLY WITH NEW LEAKAGE SITE
• VERY STRICT ABOUT FLUID PRESENCE
• OCT DONE WEEKLY
• GEOGRAPHIC ATROPHY SETTING IN BIG WAY
9. July 2013
• Patient’s RE vision 6/9 N6
• TODAY RECEIVING HIS 27 TH INJECTION OF
LUCENTIS
10.
11.
12.
13.
14. FLASHBACK
• 15 YEARS AGO
• STARTED WITH WET AMD IN LEFT EYE
• LIFE SENTENCE FOR BLINDNESS
• MEDIEVAL TREATMENT
• TTT
• PDT
• LASER TO FEEDER ETC
15. FLASHBACK
• 10 YEARS AGO IN NOV 2005
• DEATH SENTENCE
• WET AMD IN RIGHT EYE
• STARTED WITH PDT
• MAY2006 GOT THE ELIXIR OF SIGHT LUCENTIS
• LEFT EYE WAS LOST IN THE PRE VEGEF ERA
• PARADIGM SHIFT WITH LUCENTIS
16. History
• 84 year old male
• Strong family history of AMD
• LE – Diagnosed with AMD 12 years ago(2001),
Underwent 2 TTT’s, 3 PDT’s with IVTA, now
has macular scar with Vn of HM
20. Serial OCTs
Sep 05 – PDT
done
May 06 – post lucentis –
3 injections at 2 monthly
intervals
May 06 – fluid 6
months later –
Lucentis started
21. Serial OCTs - PEDs with fluid
Sep 05 – PDT
done
May 06 – post lucentis –
3 injections at 2 monthly
intervals
May 06 – fluid 6
months later –
Lucentis started
22. Serial OCTs
May 07 – Fluid 8 months
after last injection – needed
injection every 3 months
since..
Jan 09 – eg of OCT post
injection
March 09 – fluid in 3
months – Thickening
of same parafoveal
area every 3 months
23. Serial OCTs
May 07 – Fluid 8 months
after last injection – needed
injection every 3 months
since..
Jan 09 – eg of OCT post
injection
March 09 – fluid in 3
months – Thickening
of same parafoveal
area every 3 months
27. • Retrospective study involving 192 eyes from 172 patients.
• For a patient to be eligible for switch, at least three
consecutive monthly injections must have been administered.
Paper 1:
Aflibercept Switch after at least three Ranibizumab or Bevacizumab inj
30. * NO added benefit in case of Responders
- No further functional or anatomical improvement despite switch
31. Take Away from Paper 1
• Aflibercept could be considered in Ranibizumab
or Bevacizumab treated patients who respond
sub-optimally or poorly after at least three
consecutive injections
• No benefit to aflibercept switch if patient has
responded good / optimally after three
consecutive monthly injections of Ranibizumab
or Bevacizumab
33. 47 eyes of 45 patients of neovascular AMD treated
Initially with Ranibizumab, then Aflibercept ; and later
again switched to Ranibizumab
T0 -- T1 : Switch from Ranibizumab to Aflibercept
T1 – T2 : Switching back from Aflibercept to Ranibizumab
34. Take Away: Paper 2
Switch back to the prior agent (in this case
Ranibizumab) also helps !
35. Questions to Audience
• Paper 1 & Paper 2: What should we do !!!!
• How to define Response to anti-VEGF
- Good / poor / suboptimal / non-responder
- Tachyphylaxis / Tolerance / Drug Resistance: Patients doing very well
for first eight to ten months but showing decreased efficacy later on; and also ..
vice versa... patients showing poor response initially but gradually showing good
response..)
• When to consider switch ?
• Non-responder to particular anti-VEGF or All modes of the treatment
(consider scar, atrophy, genetic make-up, under treatment, misdiagnosis)
