In the ongoing push towards treat-and-extend, “we are always looking for earlier markers for re-treatment,” he said. “In some of these cases, reperfusion has already occurred at week 3, and then 2-3 weeks later fluid returns. That’s what we’re trying to avoid.”
His advice is to take an OCT after week 1 (and if there is no change on OCT, change to a different anti-VEGF), and retreat when the vessel becomes reperfused, not when fluid returns.
Until there is a way to measure VEGF levels non-invasively, Dr. Tornambe believes early OCTs are the most effective way to measure treatment efficacy. He did caution that “we absolutely cannot generalize from this single case that bevacizumab is an inferior drug—it just did not work well on this particular CNVM. We must also ensure the OCT slices through the same area of the CNV complex, otherwise changes noted in the CNV perfusion may be due to an artifact.”
Paul Tornambe, MD
E: [email protected]
Dr. Tornambe does not have any financial disclosures related to his comments.