title: Treating the untreatable patient: current options for the management of treatment-resistant neovascular age-related macular degeneration.
abstract: Anti-vascular endothelial growth factor (anti-VEGF) agents represent the current standard of care for neovascular age-related macular degeneration (nAMD). Although effective in a majority of cases, a significant proportion of patients have persisting retinal exudation despite regular anti-VEGF therapy. This exudation is considered to produce poorer visual outcomes in these patients. Some of these patients may have misdiagnosed nAMD variants such as polypoidal choroidal vasculopathy; however, the majority of these eyes have what has been termed treatment-resistant nAMD. Currently, the best way to care for these patients is uncertain. Here, we review the evidence for different approaches to the management of treatment-resistant nAMD, including high-dose anti-VEGF therapy, combination regimes and switching of anti-VEGF agents, and discuss possible therapeutic approaches for patients with treatment-resistant nAMD.
authors.affiliation: Sydney Institute of Vision Science, Sydney, NSW, Australia; Save Sight Institute, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Broadhead
authors.forename: Thomas
authors.initials: T
authors.lastname: Hong
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Chang
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004351:Drug Resistance; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D006801:Humans; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A
keywords: anti-vascular endothelial growth factor; neovascular age-related macular degeneration; refractory; treatment-resistant