Subgroups and Features of Poor Responders to Anti-Vascular Endothelial Growth Factor Treatment in Eyes with Neovascular Age-Related Macular Degeneration

OBJECTIVES: This study aimed to determine the incidence of poor response to intravitreal (IV) anti-VEGF treatment in neovascular age-related macular degeneration (nvAMD) and to define subgroups of poor responders. MATERIALS AND METHODS: A total of 235 treatment-naive eyes of 202 patients completed this prospective study. Patients younger than 50 years of age and those with a contraindication for anti-VEGF therapy were excluded. All eyes were treated with IV ranibizumab. Poor response was defined as recurrence, persistence, or worsening despite treatment. Poor responders were classified into subgroups based on progression patterns. RESULTS: Of the 235 eyes, 78 (33.2%) showed poor response. Pigment epithelial detachment (PED) and occult choroidal neovascularization (CNV) were more common among poor responders (p<0.001) and 5 subgroups were identified. CONCLUSION: Poor response to anti-VEGF treatment is not uncommon and occult CNV and PED are frequently seen in these eyes. Various subgroups can be defined based on clinical features.