Current Strategies for the Management of Treatment-Resistant Neovascular Age-Related Macular Degeneration

Abstract

While intravitreal anti-vascular endothelial growth factor (VEGF) therapy is currently the standard of care for the treatment of neovascular age-related macular degeneration, there are some eyes which show varying degrees of treatment resistance manifested as persistent or increasing signs of exudation, often associated with vision loss. Numerous therapeutic strategies have been proposed to manage these challenging cases including increasing the dose of the same anti-VEGF agent, increasing the frequency of administration of anti-VEGF therapy, switching to a different anti-VEGF agent, and combining anti-VEGF therapy with another treatment modality, most commonly verteporfin photodynamic therapy. This manuscript will review our definition of treatment resistance, discuss its possible causes, and review the rationale and outcomes for the various management options used in these patients.