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Kawashima Y, Hata M, Miyake M, Kusaka M, Oishi A, Ooto S, Tamura H, Miyata M, Uji A, Ueda-Arakawa N, Takahashi A, Tsujikawa A. MACULAR CHORIORETINAL ATROPHY AND VISUAL OUTCOMES IN RANIBIZUMAB- OR AFLIBERCEPT-TREATED MYOPIC CHOROIDAL NEOVASCULARIZATION. Retina 2024; 44:127-135. [PMID: 37695978 DOI: 10.1097/iae.0000000000003930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
PURPOSE To investigate the predictors of macular chorioretinal atrophy, consisting of patchy atrophy (PA) at the macula and choroidal neovascularization (CNV)-related macular atrophy (CNV-MA), during treatment with ranibizumab or aflibercept for myopic CNV (mCNV) and its impact on visual outcomes. METHODS This retrospective study included 82 eyes with treatment-naïve mCNV who were treated with pro re nata injections of ranibizumab or aflibercept. RESULTS Nine eyes (11.0%) presented with macular PA at baseline (PA group), and 73 eyes (89.0%) did not (non-PA group). VA improved during the first year in the non-PA group; a similar trend was noted in the PA group until 3 months after initial treatment. This improvement was maintained until 24 months ( P < 0.001) in the non-PA group, but not in the PA group. In the PA group, macular chorioretinal atrophy progressed faster ( P < 0.0001), and CNV-MA was more frequent during the 2 years of treatments ( P = 0.04). Even non-PA group eyes sometimes developed CNV-MA (42% at Month 24) if they had a larger CNV and thinner subfoveal choroidal thickness at baseline, resulting in poorer visual prognosis ( P < 0.01). CONCLUSION Macular PA at baseline was a risk factor for CNV-MA development and was associated with poor visual outcomes.
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Affiliation(s)
- Yu Kawashima
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Ophthalmology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan; and
| | - Masayuki Hata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mami Kusaka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Oishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoko Ueda-Arakawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Xie S, Lu H, Chen C, Xiong J, Wang Y, Uramoto K, Kamoi K, Onishi Y, Ohno-Matsui K. MORPHOLOGIC CHARACTERISTICS AND PROGRESSION PATTERNS OF MACULAR NEOVASCULARIZATION-RELATED ATROPHY IN EYES WITH PATHOLOGIC MYOPIA. Retina 2023; 43:1662-1672. [PMID: 37343303 DOI: 10.1097/iae.0000000000003863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
PURPOSE To investigate the development and progression patterns of macular neovascularization (MNV)-related atrophies in eyes with pathologic myopia. METHODS Twenty-seven eyes of 26 patients with MNV followed from its onset to progression to macular atrophy were studied. A longitudinal series of autofluorescence and optical coherence tomography images were examined for the patterns of MNV-related atrophy. Changes in best-corrected visual acuity were determined for each pattern. RESULTS The mean age was 67.2 ± 8.7 years. The mean axial length was 29.6 ± 1.5 mm. Three patterns of atrophy were identified: multiple-atrophic pattern, 63% of the eyes had small atrophies occurring at multiple sites around the MNV edge; single-atrophic pattern, 18.5% had atrophies occurring only on one side of the MNV edge; and exudation-related pattern, 18.5% had atrophy occurring within a previous serous exudation or hemorrhagic area and slightly away from the MNV edge. Eyes with atrophies in multiple-atrophic and exudation-related patterns progressed to large macular atrophies involving the central fovea and showed decrease in best-corrected visual acuity during the 3-year follow-up period. Eyes with single-atrophic pattern had a sparing of the fovea and had good recovery of the best-corrected visual acuity. CONCLUSION There are three patterns of MNV-related atrophy in eyes with pathologic myopia with different courses of progression.
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Affiliation(s)
- Shiqi Xie
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
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Woronkowicz M, Hamilton R, Lightman S, Zagora S, Tomkins-Netzer O. Comparison of anatomical and functional outcomes of treating myopic choroidal neovascularization with bevacizumab or ranibizumab. Int Ophthalmol 2023; 43:3499-3507. [PMID: 37318668 DOI: 10.1007/s10792-023-02755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/21/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE To compare results of treatment with bevacizumab and ranibizumab injections in myopic choroidal neovascularization (mCNV). METHODS Retrospective, observational case series. PARTICIPANTS patients with mCNV treated with bevacizumab or ranibizumab injections. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) on optical coherence tomography (OCT) scans were collected at baseline, after 3, 6, 12, 24 months and the last visit. MAIN OUTCOME MEASURES mean change in BCVA and CRT. RESULTS We included 85 eyes treated with bevacizumab and 125 eyes treated with ranibizumab. There was no difference between the groups regarding BCVA and CRT change. CNV recurrence occurred at the mean time of 66.1 ± 3.7 and 57.3 ± 6.4 months in the bevacizumab- and ranibizumab-treated eyes, respectively (p = 0.006). During the first year 6.9% eyes in the bevacizumab group vs. 27.5% in the ranibizumab group had CNV recurrence (p = 0.001). Risk factors for recurrence of CNV were baseline CNV area (aHR 1.20, 95%CI 1.0-1.32, p = 0.04), subfoveal CNV (aHR 2.13, 95% CI 1.16-3.93, p = 0.01) and ranibizumab treatment (aHR 2.31, 95% CI 1.16-3.93, p = 0.008). CONCLUSION Eyes treated with bevacizumab and ranibizumab can achieve similar anatomical and functional improvement. CNV recurrence may occur earlier and more frequently during the first year in eyes treated with ranibizumab.
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Affiliation(s)
- Malgorzata Woronkowicz
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.
- UCL Institute of Ophthalmology, London, UK.
| | - Robin Hamilton
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, London, UK
| | - Sue Lightman
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, London, UK
| | - Sophia Zagora
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
- Sydney Eye Hospital, Sydney, Australia
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, London, UK
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Bae KW, Kim DI, Kim BH, Oh BL, Lee EK, Yoon CK, Park UC. Risk factors for myopic choroidal neovascularization-related macular atrophy after anti-VEGF treatment. PLoS One 2022; 17:e0273613. [PMID: 36137056 PMCID: PMC9499232 DOI: 10.1371/journal.pone.0273613] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/13/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose The study aimed to evaluate risk factors for macular atrophy (MA) associated with myopic choroidal neovascularization (mCNV) during long-term follow-up after intravitreal anti-vascular endothelial growth factor (VEGF) treatment in highly myopic eyes. Methods The medical records of patients who received intravitreal injection of anti-VEGF agents as mCNV treatment and were followed-up for more than 36 months were retrospectively reviewed. The risk factors for the development of mCNV-MA, which is the fovea-involving patchy atrophy lesion adjacent to mCNV, were investigated using the Cox proportional hazard model. Results A total of 82 eyes (74 patients) were included in the study. The mean age at anti-VEGF treatment was 56.3 ± 12.5 years (range, 26–77), and the mean follow-up period was 76.3 ± 33.5 months (range, 36–154). During follow-up, mCNV-MA developed in 27 eyes (32.9%), and its occurrence was estimated to be 24.5% at 3 years and 37.3% at 5 years after the first anti-VEGF treatment. Old age (hazard ratio [HR] = 1.054, 95% confidence interval [CI]: 1.018–1.091; P = 0.003) and greater CNV size at baseline (HR = 2.396, CI: 1.043–5.504; P = 0.040) were significant factors for mCNV-MA development. Eyes with a thinner subfoveal choroid were more likely to show faster enlargement of the mCNV-MA during follow-up. Conclusions In mCNV eyes treated with intravitreal anti-VEGF agents, older age and greater mCNV size at baseline were risk factors for the development of MA during long-term follow-up, which was associated with a poor visual prognosis.
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Affiliation(s)
- Ki Woong Bae
- Department of Ophthalmology, Hangil Eye Hospital, Incheon, Korea
| | - Dong Ik Kim
- Department of Ophthalmology, Hangil Eye Hospital, Incheon, Korea
| | - Bo Hee Kim
- Department of Ophthalmology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong, Korea
| | - Baek-Lok Oh
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Kyoung Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Ki Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Un Chul Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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Gabrielle P, Nguyen V, Creuzot‐Garcher C, Miguel L, Alforja S, Sararols L, Casaroli‐Marano RP, Zarranz‐Ventura J, Gillies M, Arnold J, Barthelmes D. Vascular endothelial growth factor inhibitors for predominantly Caucasian myopic choroidal neovascularization: 2-year treatment outcomes in clinical practice: data from the Fight Retinal Blindness! Registry. Acta Ophthalmol 2022; 100:e288-e296. [PMID: 33960115 PMCID: PMC9290852 DOI: 10.1111/aos.14893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/08/2021] [Accepted: 04/10/2021] [Indexed: 01/22/2023]
Abstract
Purpose To report the 24‐month outcomes of vascular endothelial growth factor (VEGF) inhibitors for myopic choroidal neovascularization (mCNV) in predominantly Caucasian eyes in routine clinical practice. Methods Retrospective analysis of treatment‐naïve eyes starting intravitreal injection of VEGF inhibitors of either bevacizumab (1.25 mg) or ranibizumab (0.5 mg) for mCNV from 1 January 2006 to 31 May 2018 that were tracked in the Fight Retinal Blindness! registry. Results We identified 203 eyes (bevacizumab–85 and ranibizumab–118) of 189 patients. The estimated mean (95% CI) change in VA over 24 months for all eyes using longitudinal models was +8 (5, 11) letters with a median (Q1, Q3) of 3 (2, 5) injections given mostly during the first year. The estimated mean change in VA at 24 months was similar between bevacizumab and ranibizumab [+9 (5, 13) letters for bevacizumab versus +9 (6, 13) letters for ranibizumab; p = 0.37]. Both agents were also similar in the mCNV activity outcomes, treatment frequency and visit frequency. Conclusions The 24‐month treatment outcomes of VEGF inhibitors for mCNV were favourable in this largest series yet reported of predominantly Caucasian eyes in routine clinical practice, with approximately two lines of visual gain and a median of three injections given mostly during the first year. These outcomes are similar to those reported for predominantly Asian eyes. Bevacizumab appeared to be as safe and effective as ranibizumab.
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Affiliation(s)
- Pierre‐Henry Gabrielle
- Discipline of Ophthalmology Save Sight Institute Sydney Medical School The University of Sydney Sydney NSW Australia
- Department of Ophthalmology Dijon University Hospital Dijon France
| | - Vuong Nguyen
- Discipline of Ophthalmology Save Sight Institute Sydney Medical School The University of Sydney Sydney NSW Australia
| | | | - Lucia Miguel
- Clinical Institute of Ophthalmology (ICOF) Hospital Clinic Barcelona Spain
| | - Socorro Alforja
- Clinical Institute of Ophthalmology (ICOF) Hospital Clinic Barcelona Spain
| | | | - Ricardo P. Casaroli‐Marano
- Clinical Institute of Ophthalmology (ICOF) Hospital Clinic Barcelona Spain
- University of Barcelona Barcelona Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Barcelona Spain
| | - Javier Zarranz‐Ventura
- Clinical Institute of Ophthalmology (ICOF) Hospital Clinic Barcelona Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Barcelona Spain
| | - Mark Gillies
- Discipline of Ophthalmology Save Sight Institute Sydney Medical School The University of Sydney Sydney NSW Australia
| | | | - Daniel Barthelmes
- Discipline of Ophthalmology Save Sight Institute Sydney Medical School The University of Sydney Sydney NSW Australia
- Department of Ophthalmology University Hospital Zurich University of Zurich Zurich Switzerland
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Ten-Year Outcomes of Intravitreal Bevacizumab for Myopic Choroidal Neovascularization: Analysis of Prognostic Factors. Pharmaceuticals (Basel) 2021; 14:ph14101042. [PMID: 34681267 PMCID: PMC8541117 DOI: 10.3390/ph14101042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 11/16/2022] Open
Abstract
The current standard treatment of myopic choroidal neovascularisation (mCNV) is intravitreal injection of VEGF antagonists. This study was proposed to assess efficacy and safety of intravitreal bevacizumab (IVB) for the treatment of mCNV across a 10-year follow-up. Thirty eyes of thirty patients with treatment-naïve mCNV who underwent IVB and were followed up with for a minimum of ten years were recruited for the present retrospective cohort study. All participants were treated with three monthly IVB at baseline and then evaluated and treated under pro re nata (PRN) schedule. Outcome measures were to determine BCVA changes over years and identify the predictive factors of both final visual outcome and need for retreatment. Analysis of the main involved prognostic factors with correlations among variables is reported. Visual acuity remained stable at 10-year follow-up (p = 0.001) with the greatest improvement at 2 years (p < 0.0001) in all CNV locations. Baseline BCVA correlated positively with final BCVA (β = 0.88, p < 0.0001, R2: 0.75). No predictive factors for the need of additional injections were identified. Retinal and choroidal thickness significantly reduced over time but without correlation with the number of injections. CNV max height and area significantly decreased at 10 years (p < 0.0001 and p = 0.003, respectively), with complete regression of mCNV lesion in 40% of subjects. Intravitreal bevacizumab resulted as long-term effective and safe therapy for mCNV with sustained results at 10 years.
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Ng DSC, Ho M, Iu LPL, Lai TYY. Safety review of anti-VEGF therapy in patients with myopic choroidal neovascularization. Expert Opin Drug Saf 2021; 21:43-54. [PMID: 34228553 DOI: 10.1080/14740338.2021.1952979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Anti-angiogenesis therapy with intravitreal anti-VEGF agents is now the standard-of-care treatment for myopic choroidal neovascularization (CNV). AREAS COVERED We provide a critical review of the safety of all the anti-VEGF agents currently used for treating myopic CNV including ranibizumab, aflibercept, conbercept, bevacizumab, and ziv-aflibercept. EXPERT OPINION Anti-VEGF therapy for myopic CNV with the currently available anti-VEGF drugs generally have favorable safety outcomes in the short-term. Nonetheless, ocular adverse events following anti-VEGF therapy for myopic CNV may develop and these include worsening or new development of myopic traction maculopathy, increased risk of retinal detachment, and progression of chorioretinal atrophy. Clinicians should be aware of these potential complications and evaluate them before and after anti-VEGF therapy.
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Affiliation(s)
- Danny S C Ng
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Mary Ho
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, New Territories, Hong Kong
| | - Lawrence P L Iu
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, New Territories, Hong Kong
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,2010 Retina and Macula Centre, Kowloon, Hong Kong
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Ueda-Consolvo T, Shibuya N, Oiwake T, Abe S, Numata A, Honda Y, Yanagisawa S, Hayashi A. Using optical coherence tomography angiography to guide myopic choroidal neovascularization treatment: a 3-year follow-up study. Graefes Arch Clin Exp Ophthalmol 2021; 259:3295-3303. [PMID: 34142188 DOI: 10.1007/s00417-021-05270-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/20/2021] [Accepted: 06/03/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To report the long-term changes of the size of myopic choroidal neovascularization (mCNV) using optical coherence tomography angiography (OCTA). METHODS This was a retrospective, observational case study of eleven eyes in eleven patients with mCNV followed with OCTA for a minimum of 3 years. The flow area of mCNV on OCTA, the size of chorioretinal atrophy (CRA) and central choroidal thickness were analyzed. The relationship between the changes of mCNV size and recurrences treated with anti-vascular endothelial growth factor (VEGF) agents was also assessed. RESULTS Three eyes out of eleven eyes showed enlargement of the mCNV over 3 years. In two of the three eyes, the mCNV recurrences had not been treated immediately (the examination intervals were 4 months and 5 months, respectively), and we found obvious enlargement of the mCNV. In three eyes, the mCNV size decreased in 1 year and was stable thereafter without recurrences. In five eyes, mCNV size did not show remarkable changes for 3 years. In three of the five eyes, no recurrences were detected and two of the five eyes underwent prompt treatments against recurrences. CONCLUSION Regular examination and prompt treatments against recurrences are critical to prevent enlargement of mCNV.
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Affiliation(s)
- Tomoko Ueda-Consolvo
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Noriko Shibuya
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Toshihiko Oiwake
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Shinya Abe
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Ayaka Numata
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Yuuki Honda
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Shuichiro Yanagisawa
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
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Cheung CMG, Ohno‐Matsui K, Wong TY, Li T, Asmus F, Leal S. Influence of myopic macular degeneration severity on treatment outcomes with intravitreal aflibercept in the MYRROR study. Acta Ophthalmol 2019; 97:e729-e735. [PMID: 30690902 DOI: 10.1111/aos.14035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/15/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the influence of baseline myopic macular degeneration (MMD) severity on outcomes with intravitreal aflibercept (IVT-AFL) in patients with myopic choroidal neovascularization (CNV). METHODS MYRROR was a randomized, double-masked study in patients with myopic CNV treated with IVT-AFL/sham over 48 weeks. At baseline/week 48, images were retrospectively graded for MMD. RESULTS At baseline, 115 eyes had a valid MMD grading result; at week 48, grading results were available for 99 eyes [IVT-AFL (n = 78)/sham (n = 21)]. Severity of baseline MMD was distributed as follows: category 1: 19/115 (17%); category 2: 67/115 (58%); category 3: 22/115 (19%); category 4: 7/115 (6%). Higher MMD category was associated with older age (nominal p = 0.007) and longer axial length (nominal p = 0.025). At week 48, patients in the mild and severe groups had visual acuity gains of +13.5 and +12.4 letters, respectively. Baseline MMD severity did not significantly affect visual/anatomical outcomes or number of treatments. Visual Functioning Questionnaire-25 scores improved more in mild (+5.6) versus severe (+0.4) MMD (nominal p = 0.03). There were no new safety events. CONCLUSIONS Visual acuity gains, morphological outcomes and dosing frequency were not affected by baseline MMD severity in patients treated with IVT-AFL. A benefit with IVT-AFL treatment was observed for all baseline MMD stages included in this study.
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Affiliation(s)
- Chui Ming Gemmy Cheung
- Singapore National Eye Centre Singapore Singapore
- Singapore Eye Research Institute Singapore Singapore
- Duke‐NUS Graduate Medical School National University of Singapore Singapore Singapore
| | - Kyoko Ohno‐Matsui
- Department of Ophthalmology and Visual Science Tokyo Medical and Dental University Tokyo Japan
| | - Tien Yin Wong
- Singapore National Eye Centre Singapore Singapore
- Singapore Eye Research Institute Singapore Singapore
- Duke‐NUS Graduate Medical School National University of Singapore Singapore Singapore
| | - Tummy Li
- Bayer Pharmaceuticals Beijing China
| | - Friedrich Asmus
- Bayer AG Berlin Germany
- Department of Neurodegeneration Center of Neurology University Hospital of Tübingen, and Hertie Institute for Clinical Brain Research Tübingen Germany
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Hu Q, Li H, Du Y, He J. Comparison of intravitreal bevacizumab and ranibizumab used for myopic choroidal neovascularization: A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e14905. [PMID: 30896642 PMCID: PMC6709001 DOI: 10.1097/md.0000000000014905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To evaluate the effect of intravitreal bevacizumab (IVB) and ranibizumab (IVR) for the treatment of choroidal neovascularization (CNV) secondary to pathologic myopia (PM) by meta-analysis. METHODS Pertinent publications of randomized controlled trials (RCTs) were identified through systemic searches of PubMed, EMBASE, Web of science, Cochrane Library, clinicaltrials.gov, CNKI, CQVIP, and Wanfang database. All comparative studies of IVB or IVR as treatment for CNV secondary to pathologic myopia were included. Meta-analysis of these RCTs was performed using Review Manager 5.3 software. The χ test and I values were used to analyze heterogeneity. Measurements included best-corrected visual acuity (BCVA) and central foveal thickness (CFT). RESULTS A total of 3 randomized controlled clinical trials involving 158 eyes were included, 81 eyes in IVB group and 77 eyes in IVR group. Compared with baseline, at 1, 3, 6, and 12 months after IVB or IVR treatment, BCVA was significantly increased. Change of BCVA at 1, 3, 6, and 12 months did not vary significantly between IVB and IVR group (1 month: Z = 0.30, 95% CI = -0.08 to 0.11, P = .76; 3 months: Z = 0.36, 95% CI = -0.10 to 0.15, P = .72; 6 months: Z = 0.17, 95% CI = -0.10 to 0.12, P = .86; 12 months: Z = 0.64, 95% CI = -0.15 to 0.08, P = .52). CONCLUSION Both IVR and IVB can significantly improve BCVA of eyes with mCNV, but there was no significant difference between the 2 therapies on the treatment of mCNV.
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Affiliation(s)
- Qiuming Hu
- Department of Ophthalmology, the First Affiliated Hospital of Medical University
| | - Haoyu Li
- Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Yi Du
- Department of Ophthalmology, the First Affiliated Hospital of Medical University
| | - Jianfeng He
- Department of Ophthalmology, the First Affiliated Hospital of Medical University
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Effect of intravitreal injection of aflibercept or ranibizumab on chorioretinal atrophy in myopic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol 2019; 257:749-757. [DOI: 10.1007/s00417-018-04214-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/02/2018] [Accepted: 12/06/2018] [Indexed: 11/25/2022] Open
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12
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Cheung CMG, Arnold JJ, Holz FG, Park KH, Lai TY, Larsen M, Mitchell P, Ohno-Matsui K, Chen SJ, Wolf S, Wong TY. Myopic Choroidal Neovascularization. Ophthalmology 2017; 124:1690-1711. [DOI: 10.1016/j.ophtha.2017.04.028] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 04/03/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023] Open
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CHOROIDAL THICKNESS AND CHORIORETINAL ATROPHY IN MYOPIC CHOROIDAL NEOVASCULARIZATION WITH ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY. Retina 2017; 37:1516-1522. [DOI: 10.1097/iae.0000000000001384] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Yang MC, Chen YP, Tan ECH, Leteneux C, Chang E, Chu CH, Lai CC. Epidemiology, treatment pattern and health care utilization of myopic choroidal neovascularization: a population based study. Jpn J Ophthalmol 2017; 61:159-168. [PMID: 28062929 DOI: 10.1007/s10384-016-0496-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/31/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the prevalence and incidence of myopic choroidal neovascularization (CNV) in Taiwan, including the health care utilization and treatment-associated costs. METHODS A retrospective cohort study using existing data from the Taiwanese National Health Insurance claims database to identify patients who had a diagnosis of myopic CNV recorded from 1 January 2009 to 31 December 2011. The prevalence of myopic CNV was monitored during this period, and the frequency and cost of both treatment visits and monitoring visits were analyzed for 2 years following diagnosis. RESULTS The prevalence of myopic CNV was 0.017%. In total, 9068 patients with myopic CNV were identified, 12.3% (n = 1111) of whom were treated. Of those treated, 72.0% (n = 800) received intravitreal anti-vascular endothelial growth factor injections (IVI); the remainder received either photodynamic therapy with verteporfin (vPDT), laser photocoagulation, or a combination of therapies. IVI was associated with the largest number of treatment visits as well as a higher administrative (non-drug) cost per treatment visit (a mean of USD 57.18). vPDT alone was associated with a higher overall cost per treatment visit and more monitoring visits than IVI or laser photocoagulation. Costs for monitoring visits were highest for IVI. CONCLUSIONS The prevalence of myopic CNV was lower than that reported in previous studies, possibly because of differences in age distribution in the populations studied. The frequencies of treatment administered were similar to those reported in previous studies; however, a cost-effectiveness comparison could not be made owing to lack of data in previous studies.
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Affiliation(s)
- Ming-Chin Yang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yen-Po Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-Shan, 333, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Elise Chia-Hui Tan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | | | | | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-Shan, 333, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Zhu Y, Zhang T, Xu G, Peng L. Anti-vascular endothelial growth factor for choroidal neovascularisation in people with pathological myopia. Cochrane Database Syst Rev 2016; 12:CD011160. [PMID: 27977064 PMCID: PMC6464015 DOI: 10.1002/14651858.cd011160.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Choroidal neovascularisation (CNV) is a common complication of pathological myopia. Once developed, most eyes with myopic CNV (mCNV) experience a progression to macular atrophy, which leads to irreversible vision loss. Anti-vascular endothelial growth factor (anti-VEGF) therapy is used to treat diseases characterised by neovascularisation and is increasingly used to treat mCNV. OBJECTIVES To assess the effects of anti-vascular endothelial growth factor (anti-VEGF) therapy for choroidal neovascularisation (CNV), compared with other treatments, sham treatment or no treatment, in people with pathological myopia. SEARCH METHODS We searched a number of electronic databases including CENTRAL and Ovid MEDLINE, ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform ICTRP). We did not use any date or language restrictions in the electronic searches for trials. Electronic databases were last searched on 16 June 2016. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs comparing anti-VEGF therapy with another treatment (e.g. photodynamic therapy (PDT) with verteporfin, laser photocoagulation, macular surgery, another anti-VEGF), sham treatment or no treatment in participants with mCNV. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two authors independently screened records, extracted data, and assessed risk of bias. We contacted trial authors for additional data. We analysed outcomes as risk ratios (RRs) or mean differences (MDs). We graded the certainty of the evidence using GRADE. MAIN RESULTS The present review included six studies which provided data on the comparison between anti-VEGF with PDT, laser, sham treatment and another anti-VEGF treatment, with 594 participants with mCNV. Three trials compared bevacizumab or ranibizumab with PDT, one trial compared bevacizumab with laser, one trial compared aflibercept with sham treatment, and two trials compared bevacizumab with ranibizumab. Pharmaceutical companies conducted two trials. The trials were conducted at multiple clinical centres across three continents (Europe, Asia and North America). In all these six trials, one eye for each participant was included in the study.When compared with PDT, people treated with anti-VEGF agents (ranibizumab (one RCT), bevacizumab (two RCTs)), were more likely to regain vision. At one year of follow-up, the mean visual acuity (VA) in participants treated with anti-VEGFs was -0.14 logMAR better, equivalent of seven Early Treatment Diabetic Retinopathy Study (ETDRS) letters, compared with people treated with PDT (95% confidence interval (CI) -0.20 to -0.08, 3 RCTs, 263 people, low-certainty evidence). The RR for proportion of participants gaining 3+ lines of VA was 1.86 (95% CI 1.27 to 2.73, 2 RCTs, 226 people, moderate-certainty evidence). At two years, the mean VA in people treated with anti-VEGFs was -0.26 logMAR better, equivalent of 13 ETDRS letters, compared with people treated with PDT (95% CI -0.38 to -0.14, 2 RCTs, 92 people, low-certainty evidence). The RR for proportion of people gaining 3+ lines of VA at two years was 3.43 (95% CI 1.37 to 8.56, 2 RCTs, 92 people, low-certainty evidence). People treated with anti-VEGFs showed no obvious reduction (improvement) in central retinal thickness at one year compared with people treated with PDT (MD -17.84 μm, 95% CI -41.98 to 6.30, 2 RCTs, 226 people, moderate-certainty evidence). There was low-certainty evidence that people treated with anti-VEGF were more likely to have CNV angiographic closure at 1 year (RR 1.24, 95% CI 0.99 to 1.54, 2 RCTs, 208 people). One study allowed ranibizumab treatment as of month 3 in participants randomised to PDT, which may have led to an underestimate of the benefits of anti-VEGF treatment.When compared with laser photocoagulation, there was more improvement in VA among bevacizumab-treated people than among laser-treated people after one year (MD -0.22 logMAR, equivalent of 11 ETDRS letters, 95% CI -0.43 to -0.01, 1 RCT, 36 people, low-certainty evidence) and after two years (MD -0.29 logMAR, equivalent of 14 ETDRS letters, 95% CI -0.50 to -0.08, 1 RCT, 36 people, low-certainty evidence).When compared with sham treatment, people treated with aflibercept had better vision at one year (MD -0.19 logMAR, equivalent of 9 ETDRS letters, 95% CI -0.27 to -0.12, 1 RCT, 121 people, moderate-certainty evidence). The fact that this study allowed for aflibercept treatment at 6 months in the control group might cause an underestimation of the benefit with anti-VEGF.People treated with ranibizumab had similar improvement in VA recovery compared with people treated with bevacizumab after one year (MD -0.02 logMAR, equivalent of 1 ETDRS letter, 95% CI -0.11 to 0.06, 2 RCTs, 80 people, moderate-certainty evidence).Of the included six studies, two studies reported no adverse events in either group and two industry-sponsored studies reported both systemic and ocular adverse events. In the control group, there were no systemic or ocular adverse events reported in 149 participants. Fifteen people reported systemic serious adverse events among 359 people treated with anti-VEGF agents (15/359, 4.2%). Five people reported ocular adverse events among 359 people treated with anti-VEGF agents (5/359, 1.4%). The number of adverse events was low, and the estimate of RR was uncertain regarding systemic serious adverse events (4 RCTs, 15 events in 508 people, RR 4.50, 95% CI 0.60 to 33.99, very low-certainty evidence) and serious ocular adverse events (4 RCTs, 5 events in 508 people, RR 1.82, 95% CI 0.23 to 14.71, very low-certainty evidence). There were no reports of mortality or cases of endophthalmitis or retinal detachment.There was sparse reporting of data for vision-related quality of life (in favour of anti-VEGF) in only one trial at one year of follow-up. The studies did not report data for other outcomes, such as percentage of participants with newly developed chorioretinal atrophy. AUTHORS' CONCLUSIONS There is low to moderate-certainty evidence from RCTs for the efficacy of anti-VEGF agents to treat mCNV at one year and two years. Moderate-certainty evidence suggests ranibizumab and bevacizumab are equivalent in terms of efficacy. Adverse effects occurred rarely and the trials included here were underpowered to assess these. Future research should be focused on the efficacy and safety of different drugs and treatment regimens, the efficacy on different location of mCNV, as well as the effects on practice in the real world.
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Affiliation(s)
- Ying Zhu
- Xiangya Hospital, Central South UniversityDepartment of OphthalmologyNo. 87, Xiangya RoadChangshaHunanChina410008
| | - Ting Zhang
- Eye and Ear Nose Throat Hospital, Shanghai Medical School, Fudan UniversityDepartment of OphthalmologyNo. 83, Fenyang RoadShanghaiChina200032
| | - Gezhi Xu
- Eye and Ear Nose Throat Hospital, Shanghai Medical School, Fudan UniversityDepartment of OphthalmologyNo. 83, Fenyang RoadShanghaiChina200032
| | - Lijun Peng
- Linyi People's Hospital affiliated to Shandong UniversityDepartment of Gastroenterology27 Jie Fang RoadLinyiShandongChina276000
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Understanding the Determinants of Myopic Choroidal Neovascularization and Response to Treatment. Eur J Ophthalmol 2016; 26:511-516. [PMID: 27515571 DOI: 10.5301/ejo.5000839] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 12/15/2022]
Abstract
Purpose The pathophysiologic pathways that govern the development of choroidal neovascularization (CNV) are complex. Patchy atrophy and lacquer cracks are known to be major anatomic risk factors for the development of myopic CNV, but they are not alone and much remains to be understood about other factors that influence development. In addition, a greater understanding of the modifiable and nonmodifiable factors that influence outcome, resolution, and recurrence after intravitreal injection of anti-vascular endothelial growth factor (VEGF) could lead to more personalized treatment algorithms that integrate parameters other than the presence of CNV itself and could help improve clinical outcomes and reduce recurrence. Methods We reviewed recently published data on risk factors for CNV and predictors of response to anti-VEGF treatments. In particular, data pertaining to age, sex, genetic predisposition, baseline visual acuity, axial length, staphyloma, lacquer cracks, atrophic lesions, choroidal thickness or choroidal thinning, characteristics of CNV such as duration, localization, and size of CNV, and treatment considerations such as choice of treatment, loading doses, and combination treatments were reviewed. Results Our analysis showed that the body of evidence is incomplete. Conclusions Additional studies are required to identify high-risk patients and to develop personalized therapeutic approaches.
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Bruè C, Pazzaglia A, Mariotti C, Reibaldi M, Giovannini A. Aflibercept as primary treatment for myopic choroidal neovascularisation: a retrospective study. Eye (Lond) 2016; 30:139-45. [PMID: 26514244 PMCID: PMC4709541 DOI: 10.1038/eye.2015.199] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/31/2015] [Indexed: 01/15/2023] Open
Abstract
AIM The aim of this study is to evaluate long-term efficacy of intravitreal injections of aflibercept as primary treatment for subfoveal/juxtafoveal myopic choroidal neovascularisation (CNV).METHODS Thirty-eight treatment-naive eyes of thirty-eight patients with subfoveal/juxtafoveal myopic CNV received initial intravitreal aflibercept injections and were followed for at least 18 months. Aflibercept was applied again for persistent or recurrent CNV, as required. Statistical analysis was carried out using SPSS.RESULTS Mean patient age was 45.8 years, and mean eye refractive error was -7.79 D. For the total patient group (n=38 eyes), mean logMAR best-corrected visual acuity (BCVA) significantly improved from 0.69 at baseline to 0.15 at 18 months (P<0.01). Over half of the treated eyes obtained resolution with one aflibercept injection. Patients were also grouped according to age, as <50 years (n=20 eyes) and ≥50 years (n=18 eyes). Mean BCVA improvement was significantly greater in eyes of the younger myopic CNV group, compared with those of ≥50 years (0.21 vs 0.35; P<0.05). The mean number of aflibercept injections was 1.8 for the <50 years myopic CNV group, and 3.6 for the ≥50 years myopic CNV group (P<0.001). Correlation between spherical equivalent refraction and final visual acuity reached statistical significance only for the <50 years myopic CNV group (P<0.001; Levene's correlation).CONCLUSIONS Intravitreal aflibercept provides long-term visual acuity improvement in myopic CNV. The <50 years old myopic CNV group had significantly fewer injections, with greater visual acuity improvement. Intravitreal aflibercept in myopic CNV does not require the three-injection loading phase used for aflibercept treatment of neovascular age-related macular degeneration.
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Affiliation(s)
- C Bruè
- Ophthalmology, Department of Neuroscience, Polytechnic University of Marche, Ancona, Italy
- Ophthalmology, Macerata Hospital, Macerata, Italy
| | - A Pazzaglia
- Ophthalmology, Sant'Orsola Hospital, Malpighi, Italy
| | - C Mariotti
- Ophthalmology, Department of Neuroscience, Polytechnic University of Marche, Ancona, Italy
| | - M Reibaldi
- Ophthalmology, G. Rodolico Vittorio Emanuele Hospital, Catania, Italy
| | - A Giovannini
- Ophthalmology, Department of Neuroscience, Polytechnic University of Marche, Ancona, Italy
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Ji L, Lv W, Xiao Y, Xu Z, Zhang X, Zhang W. Therapeutic effect of intravitreal injections of ranibizumab for the treatment of macular choroidal neovascularization caused by pathological myopia. Exp Ther Med 2015; 10:1121-1126. [PMID: 26622450 DOI: 10.3892/etm.2015.2625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 04/17/2015] [Indexed: 12/29/2022] Open
Abstract
The aim of the present study was to evaluate the clinical efficacy and safety of intravitreal ranibizumab injections for the treatment of macular choroidal neovascularization (CNV) caused by pathological myopia. Between one and four intravitreal injections of ranibizumab were administered to 61 eyes from 61 patients who were diagnosed with macular CNV caused by pathological myopia. Following injection, the best-corrected visual acuity (BCVA), central macular thickness (CMT) and fundus fluorescein angiography (FFA) findings were evaluated monthly for a period of 6 months. Among the 61 eyes, 10 eyes received one injection, 44 received two injections, six received three injections and one received four injections (average, 1.97 injections). The BCVA was 0.02±0.01 prior to treatment and 0.30±0.03 subsequent to treatment, and this difference was statistically significant (P<0.01). The CMT was reduced by an average of 45.1 µm. Regarding the FFA results, 56 eyes had no CNV fluorescence leakage and five eyes had CNV fluorescence leakage following treatment; however, the intensity of CNV fluorescence leakage in the five eyes following treatment was lower than that prior to treatment. As a treatment for pathological myopia-induced macular CNV, intravitreal injections of ranibizumab may improve eyesight as well as the macular retinal tissue structure; thus, this is a safe and effective treatment method.
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Affiliation(s)
- Leibing Ji
- PLA Ophthalmic Center, No. 474 Hospital of the Chinese PLA, Urumqi, Xinjiang Uyghur Autonomous Region 830011, P.R. China
| | - Wenjuan Lv
- PLA Ophthalmic Center, No. 474 Hospital of the Chinese PLA, Urumqi, Xinjiang Uyghur Autonomous Region 830011, P.R. China
| | - Yun Xiao
- PLA Ophthalmic Center, No. 474 Hospital of the Chinese PLA, Urumqi, Xinjiang Uyghur Autonomous Region 830011, P.R. China
| | - Zhenghua Xu
- PLA Ophthalmic Center, No. 474 Hospital of the Chinese PLA, Urumqi, Xinjiang Uyghur Autonomous Region 830011, P.R. China
| | - Xiaoling Zhang
- PLA Ophthalmic Center, No. 474 Hospital of the Chinese PLA, Urumqi, Xinjiang Uyghur Autonomous Region 830011, P.R. China
| | - Wei Zhang
- The Graduate School, Shihezi University, Shihezi, Xinjiang 832000, P.R. China
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FACTORS INFLUENCING NEED FOR RETREATMENT AND LONG-TERM VISUAL OUTCOME AFTER INTRAVITREAL BEVACIZUMAB FOR MYOPIC CHOROIDAL NEOVASCULARIZATION. Retina 2015; 35:2457-68. [DOI: 10.1097/iae.0000000000000610] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR CHOROIDAL NEOVASCULARIZATION SECONDARY TO PATHOLOGIC MYOPIA. Retina 2015; 35:2450-6. [PMID: 26049616 DOI: 10.1097/iae.0000000000000632] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Evaluation of Idiopathic Choroidal Neovascularization with Indocyanine Green Angiography in Patients Undergoing Bevacizumab Therapy. J Ophthalmol 2015; 2015:642624. [PMID: 26113990 PMCID: PMC4465762 DOI: 10.1155/2015/642624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/17/2015] [Accepted: 05/24/2015] [Indexed: 12/03/2022] Open
Abstract
Purpose. To examine the clinical implications of change in choroidal neovascularization (CNV) size on indocyanine green (ICG) angiography in subjects with idiopathic CNV undergoing bevacizumab therapy. Methods. The charts of subjects with an idiopathic CNV treated by a modified PRN regimen with intravitreal bevacizumab over a 12-month period were retrospectively reviewed. Results. There were 34 subjects included in the analysis. Baseline CNV sizes of less than 1.0 mm2 on ICG angiography correlated with complete CNV resolution (P = 0.0404), fewer injections delivered (P = 0.0002), and better Snellen visual acuity (P = 0.0098) at 12 months. Subjects that experienced a 33% or more reduction in CNV size on ICG angiography at 2 months had complete CNV resolution (P = 0.0047) and fewer injections (P < 0.0001) at 12 months compared to subjects that did not experience a 33% or more reduction in CNV size on ICG angiography at 2 months. Conclusions. Smaller baseline CNV size on ICG angiography resulted in better visual acuity and fewer injections at 12 months, and a reduction of 33% or more in CNV size after 2 months may predict a better clinical course in subjects with idiopathic CNV undergoing bevacizumab therapy.
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Ohno-Matsui K, Kawasaki R, Jonas JB, Cheung CMG, Saw SM, Verhoeven VJ, Klaver CC, Moriyama M, Shinohara K, Kawasaki Y, Yamazaki M, Meuer S, Ishibashi T, Yasuda M, Yamashita H, Sugano A, Wang JJ, Mitchell P, Wong TY, Ohno-Matsui K, Moriyama M, Shinohara K, Kawasaki R, Kawasaki Y, Yamazaki M, Jonas JB, Cheung CMG, Saw SM, Wong TY, Verhoeven VJ, Klaver CC, Meuer S, Klein R, Klein BE, Ishibashi T, Yasuda M, Sugano A, Yamashita H, Wang JJ, Mitchell P, Wang NL, Hashemi H, Fotouhi A, Polašek O, Vitart V, Wilson JF, Fleck B. International photographic classification and grading system for myopic maculopathy. Am J Ophthalmol 2015; 159:877-83.e7. [PMID: 25634530 DOI: 10.1016/j.ajo.2015.01.022] [Citation(s) in RCA: 465] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 01/17/2015] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To develop a classification and grading system for myopic maculopathy. DESIGN Development and evaluation of a classification system for myopic maculopathy based on observational case series. METHODS A comprehensive set of myopic macular lesions was defined via literature review and through consensus meetings among retinal specialists and clinician scientists. A classification of myopic maculopathy was formulated based on fundus photographs and a modified Delphi process and consensus. Inter- and intraobserver reproducibility, assessed as agreement (%) and weighted kappa values, were evaluated. One hundred retinal photographs with myopia and myopic macular lesions were selected from case series at the High Myopia Clinic of the Tokyo Medical and Dental University, Tokyo, Japan. RESULTS We defined 5 categories of myopic maculopathy including "no myopic retinal degenerative lesion" (Category 0), "tessellated fundus" (Category 1), "diffuse chorioretinal atrophy" (Category 2), "patchy chorioretinal atrophy" (Category 3), and "macular atrophy" (Category 4). Three additional features to supplement these categories were defined as "plus" lesions, namely, lacquer cracks, myopic choroidal neovascularization, and Fuchs spot. Posterior staphyloma was considered as a further, important sign of myopic retinopathy. The intraobserver agreement was ≥85% and the corresponding weighted kappa statistic was ≥0.6 between observations. After a brief training session, interobserver kappa statistics reached the predefined satisfactory level (≥0.4), considered as above moderate agreement. CONCLUSIONS We propose a classification system for myopic maculopathy that was found to be reproducible. Applying a uniform classification in different studies will facilitate communication and comparison of findings from clinical trials and epidemiologic studies.
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El Matri L, Chebil A, Kort F. Current and emerging treatment options for myopic choroidal neovascularization. Clin Ophthalmol 2015; 9:733-44. [PMID: 25987831 PMCID: PMC4422283 DOI: 10.2147/opth.s49437] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Choroidal neovascularization (CNV) is the main cause of visual impairment in highly myopic patients younger than 50 years of age. There are different treatments for myopic CNV (mCNV), with 5- to 10-year outcomes currently. Chorioretinal atrophy is still the most important determinant factor for visual outcome. The purpose of this study is to provide an overview of the current treatments for mCNV, including laser, surgical management, verteporfin photodynamic therapy, and mainly anti-vascular endothelial growth factor therapy. Emerging treatment options are also discussed.
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Affiliation(s)
- Leila El Matri
- Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Faculty of Medicine of Tunis, University of El Manar, Tunis, Tunisia
| | - Ahmed Chebil
- Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Faculty of Medicine of Tunis, University of El Manar, Tunis, Tunisia
| | - Fedra Kort
- Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Faculty of Medicine of Tunis, University of El Manar, Tunis, Tunisia
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Association of cartilage degeneration with four year weight gain--3T MRI data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2015; 23:525-31. [PMID: 25591445 PMCID: PMC4368476 DOI: 10.1016/j.joca.2014.10.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 09/02/2014] [Accepted: 10/11/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effect of weight gain on progression of early knee morphologic abnormalities using magnetic resonance imaging (MRI) in a longitudinal study over 48 months. DESIGN We studied the right knee of 100 subjects from the Osteoarthritis Initiative (OAI), selecting subjects aged ≥ 45 with osteoarthritis (OA) risk factors who demonstrated weight gain (minimum 5% increase in body mass index, BMI, n = 50) or no change in weight (BMI change < 2%, n = 50), frequency matched for age, gender, and baseline BMI. Baseline and 48 month knee MRI studies were scored for lesions using a modified whole organ MRI score (WORMS). Logistic regression models were used to compare the differences between the two groups. RESULTS The odds of worsening maximum cartilage (11.3, 95%, CI 3.5-51.4) and meniscal WORMS (4.5, 95% CI 1.4-17.3) were significantly greater in the weight gain group compared to the no change group, in addition to the odds of worsening cartilage defects at the patella and average meniscal WORMS (P < 0.05). Odds of worsening average bone marrow edema pattern (BMEP) were significantly greater for the weight gain group compared to the no change cohort (P < 0.05). CONCLUSION Our study demonstrated that weight gain is strongly associated with increased progression of cartilage degeneration in middle-aged individuals with risk factors for OA.
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COMPARISON OF VISUAL PROGNOSES BETWEEN NATURAL COURSE OF SIMPLE HEMORRHAGE AND CHOROIDAL NEOVASCULARIZATION TREATED WITH INTRAVITREAL BEVACIZUMAB IN HIGHLY MYOPIC EYES. Retina 2015; 35:429-34. [DOI: 10.1097/iae.0000000000000332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A randomized trial of intravitreal bevacizumab vs. ranibizumab for myopic CNV. Graefes Arch Clin Exp Ophthalmol 2014; 253:1867-72. [DOI: 10.1007/s00417-014-2886-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022] Open
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LONG-TERM FUNCTIONAL AND MORPHOLOGIC RETINAL CHANGES AFTER RANIBIZUMAB AND PHOTODYNAMIC THERAPY IN MYOPIC CHOROIDAL NEOVASCULARIZATION. Retina 2014; 34:2053-62. [DOI: 10.1097/iae.0000000000000201] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Teo K, Cheung CMG. Choroidal neovascularization secondary to pathological myopia. World J Ophthalmol 2014; 4:35-46. [DOI: 10.5318/wjo.v4.i3.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/30/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
Myopic choroidal neovascularization (mCNV), one of the complications of pathological myopia, is also one of the leading causes of visual impairment worldwide. The socioeconomic impact of mCNV in Asian countries is particularly significant due to the rising incidence of pathological myopia. There have been major advances in the treatment of mCNV in the past few years. Previous treatment modalities, such as thermal laser photocoagulation and photodynamic therapy, aimed to prevent vision loss; however, newer modalities such as intravitreal anti-vascular endothelial growth factor (VEGF) agents have been shown to successfully restore vision in many patients. Challenges remain as long term safety and efficacy of anti-VEGF agents are unknown. This article aims to provide a review of the literature of the epidemiology, progression, clinical course and treatment modalities as well as areas of future developments related to myopic CNV.
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Wong TY, Ohno-Matsui K, Leveziel N, Holz FG, Lai TY, Yu HG, Lanzetta P, Chen Y, Tufail A. Myopic choroidal neovascularisation: current concepts and update on clinical management. Br J Ophthalmol 2014; 99:289-96. [PMID: 24990871 PMCID: PMC4345796 DOI: 10.1136/bjophthalmol-2014-305131] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Choroidal neovascularisation (CNV) is a common vision-threatening complication of myopia and pathological myopia. Despite significant advances in understanding the epidemiology, pathogenesis and natural history of myopic CNV, there is no standard definition of myopic CNV and its relationship to axial length and other myopic degenerative changes. Several treatments are available to ophthalmologists, but with the advent of new therapies there is a need for further consensus and clinical management recommendations. Verteporfin photodynamic therapy has been an established treatment for subfoveal myopic CNV for many years, but this treatment does not restore visual acuity and is associated with long-term chorioretinal atrophy. More recently, clinical trials investigating the efficacy and safety of anti-vascular endothelial growth factor agents in patients with myopic CNV have demonstrated substantial visual acuity gains and quality of life increases compared with photodynamic therapy. These enhanced outcomes provide updated evidence-based clinical management guidelines of myopic CNV, and increase the need for a generally accepted definition for myopic CNV. This review critically summarises the latest myopic CNV literature in the context of clinical experience and recommends a myopic CNV treatment algorithm.
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Affiliation(s)
- Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nicolas Leveziel
- Faculté de Médecine de Poitiers, Department of Ophthalmology, Poitiers, France
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Timothy Y Lai
- Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, The Chinese University of Hong Kong, People's Republic of China
| | - Hyeong Gon Yu
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Paolo Lanzetta
- Department of Ophthalmology, University of Udine, Piazzale S. Maria della Misericordia, Udine, Italy
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Adnan Tufail
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
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Freitas-da-Costa P, Pinheiro-Costa J, Carvalho B, Falcão M, Brandão E, Falcão-Reis F, Carneiro Â. Anti-VEGF Therapy in Myopic Choroidal Neovascularization: Long-Term Results. Ophthalmologica 2014; 232:57-63. [DOI: 10.1159/000360307] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 02/01/2014] [Indexed: 11/19/2022]
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Sakimoto S, Sakaguchi H, Ohji M, Gomi F, Ikuno Y, Fujikado T, Kamei M, Nishida K. Consecutive case series with long-term follow-up of full macular translocation for myopic choroidal neovascularisation. Br J Ophthalmol 2014; 98:1221-5. [PMID: 24692747 DOI: 10.1136/bjophthalmol-2013-304189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To examine the long-term outcomes of full macular translocation (FMT) for myopic choroidal neovascularisation (mCNV). METHODS We evaluated a consecutive case series of 60 eyes with mCNV that underwent FMT. We assessed the best-corrected visual acuity (BCVA), fundus photographs and fluorescein angiography images, and evaluated the anatomic and visual outcomes. RESULTS The mean follow-up period was 76.3 months. The macula was relocated successfully in all eyes. The mean distance of macular translocation was 2842 μm. The baseline BCVA was 0.78 logarithm of the minimum angle of resolution (logMAR) unit; the logMAR BCVA values at 1, 3 and 5 years postoperatively significantly (p<0.001) improved to 0.54 at 1 year and then remained stable. The new fovea was associated with enlargement of the myopic chorioretinal atrophy in 19 (31.7%) eyes. Subfoveal or juxtafoveal CNV at the translocated new fovea developed in five (8.3%) eyes. CONCLUSIONS FMT for mCNV maintained the improvement in VA for more than 5 years. However, postoperative complications and progression of chorioretinal atrophy due to myopia still seem to limit the visual improvement after FMT for mCNV.
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Affiliation(s)
- Susumu Sakimoto
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirokazu Sakaguchi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masahito Ohji
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Ikuno
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Fujikado
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Motohiro Kamei
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
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Intravitreal anti-vascular endothelial growth factor for choroidal neovascularization secondary to pathologic myopia: systematic review and meta-analysis. Retina 2014; 33:1375-92. [PMID: 23514793 DOI: 10.1097/iae.0b013e31827d260a] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSES To update existing evidence and evaluate intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections for myopic choroidal neovascularization. METHODS The authors conducted comprehensive search in PubMed, EMBASE, Cochrane Library, Biosis Preview, and LILACS. Included studies were categorized by study design. Comparative studies were classified as randomized controlled trials (RCTs) and non-RCT studies, and these two types of studies were presented and meta-analyzed separately for the following comparisons: 1) anti-VEGF versus photodynamic therapy, 2) anti-VEGF monotherapy versus combination therapy with photodynamic therapy, 3) single versus 3 monthly injections followed by pro re nata (PRN) treatment, and 4) ranibizumab versus bevacizumab. Noncomparative prospective series were pooled to estimate mean visual gain, mean retinal thickness change, and the average number of anti-VEGF injections required for myopic choroidal neovascularization. Ocular and systemic adverse events were also summarized. RESULTS Literature search yielded 18 comparative studies and 83 noncomparative studies. Superiority of anti-VEGF over photodynamic therapy in a 24-month period was confirmed by 2 RCTs and 6 non-RCT studies. The influence of combined photodynamic therapy was uncertain based on two non-RCT studies. Three non-RCT studies showed that the visual outcomes of 3+PRN injections might be slightly better than 1+PRN injections within 1 year. No difference was observed between ranibizumab and bevacizumab in two RCTs and one non-RCT study. The estimated visual improvement was two lines on average. Adverse events were uncommon as reported. CONCLUSION Accumulating evidence confirmed that anti-VEGF injections should be the first-line therapy for myopic choroidal neovascularization.
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Yang HS, Kim JG, Kim JT, Joe SG. Prognostic factors of eyes with naïve subfoveal myopic choroidal neovascularization after intravitreal bevacizumab. Am J Ophthalmol 2013; 156:1201-1210.e2. [PMID: 24075429 DOI: 10.1016/j.ajo.2013.08.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/31/2013] [Accepted: 08/01/2013] [Indexed: 01/11/2023]
Abstract
PURPOSE To determine the efficacy of 1 intravitreal bevacizumab injection followed by pro re nata (1 + PRN) injection in cases of subfoveal myopic choroidal neovascularization (CNV) and to identify CNV-recurrence-related prognostic factors. DESIGN Retrospective observational case series. METHODS In total, 103 eyes of 89 consecutive naive patients who had subfoveal myopic CNV and had been followed-up for at least 2 years were included. Of those eyes, 24 had recurrences. The remaining eyes were stable after the initial treatment. RESULTS The average patient age was 51.1 ± 15.2 years. The average follow-up duration was 44.1 ± 12.7 months. At baseline and at the 1-year, 2-year, and final visits, the average best corrected visual acuities (BCVAs) were 0.57 ± 0.45, 0.38 ± 0.51, 0.40 ± 0.52, and 0.41 ± 0.41 logMAR, respectively. The recurrence rate during follow-up was 23.3%. The BCVA improved by 0.2 logMAR after 2.7 injections in the eyes without recurrence but by only 0.08 logMAR after 6.9 injections in the eyes with recurrence. In univariate analysis, recurrence was associated with older age, more myopic refraction, thinner choroid, larger CNV lesions, and subfoveal hemorrhage at baseline. In multivariate analysis, only baseline CNV lesion size associated significantly with CNV recurrence (P = 0.002). Recurrence, baseline BCVA, choroidal thickness, and CNV size associated significantly with final BCVA (P = 0.026, <0.0001, 0.007, and 0.002, respectively). Baseline choroidal thickness, CNV size, age, and presence of lacquer cracks associated significantly with injection number (P < 0.0001, <0.0001, 0.026, and 0.035, respectively). CONCLUSIONS 1 + PRN intravitreal bevacizumab monotherapy effectively stabilized subfoveal myopic CNV. The CNV size, the baseline BCVA, and the choroidal thickness were the main prognostic factors of subfoveal myopic CNV after 1 + PRN injection of bevacizumab.
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Tan CS, Chew MC, Lim TH. Comparison of foveal-sparing with foveal-involving photodynamic therapy for myopic choroidal neovascularization. Eye (Lond) 2013; 28:17-22. [PMID: 24051405 DOI: 10.1038/eye.2013.204] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 08/04/2013] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the visual outcomes of choroidal neovascularization (CNV) secondary to pathological myopia in eyes treated with photodynamic therapy (PDT), and to determine the effect of lesion location and foveal involvement on visual prognosis. METHODS Interventional case series of 24 consecutive patients with myopic CNV treated with PDT. The main outcome measure was final LogMAR visual acuity (VA). RESULTS Of 24 eyes, the CNV lesion was subfoveal in 11 and extrafoveal in 13. Overall, the mean LogMAR VA at 24 months was 0.72. Extrafoveal CNV lesions achieved significantly better final VA compared with subfoveal CNV (LogMAR 0.45 vs 1.05, P=0.012). Eyes with extrafoveal CNV lesions were subdivided into foveal-sparing PDT (where the PDT laser spot did not involve the foveal center) and foveal-involved PDT (where the PDT laser covered the fovea). At all time points, the group with foveal-sparing PDT had significantly better VA compared with the foveal-involved group. The final LogMAR VA for the foveal-sparing PDT group was 0.26 compared with 1.00 for the foveal-involved PDT group (P=0.003). At 24 months, 77.8% of foveal-sparing PDT cases achieved VA of ≥ 20/40, compared with 25% of foveal-involved PDT cases and 9.1% of subfoveal CNV lesions (P=0.006). CONCLUSION For patients with myopic CNV, foveal-sparing PDT results in significantly better long-term visual outcomes compared with those with foveal-involved PDT. Foveal-sparing PDT may be of value for treatment of myopic CNV patients who are not suitable for treatment with anti-vascular endothelial growth factor injections.
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Affiliation(s)
- C S Tan
- 1] Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore [2] Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore
| | - M C Chew
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - T H Lim
- 1] Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore [2] Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore
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Ruiz-Moreno JM, Arias L, Montero JA, Carneiro A, Silva R. Intravitreal anti-VEGF therapy for choroidal neovascularisation secondary to pathological myopia: 4-year outcome. Br J Ophthalmol 2013; 97:1447-50. [DOI: 10.1136/bjophthalmol-2012-302973] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Miyake M, Yamashiro K, Akagi-Kurashige Y, Kumagai K, Nakata I, Nakanishi H, Oishi A, Tsujikawa A, Yamada R, Matsuda F, Yoshimura N. Vascular endothelial growth factor gene and the response to anti-vascular endothelial growth factor treatment for choroidal neovascularization in high myopia. Ophthalmology 2013; 121:225-233. [PMID: 23953100 DOI: 10.1016/j.ophtha.2013.06.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 06/20/2013] [Accepted: 06/25/2013] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To investigate the association between the vascular endothelial growth factor (VEGF) gene polymorphism and the response to anti-VEGF treatment for choroidal neovascularization (CNV) in highly myopic eyes. DESIGN Retrospective cohort study. PARTICIPANTS A total of 357 unrelated highly myopic Japanese patients with axial lengths ≥26.0 mm in both eyes were eligible, and 83 patients who received anti-VEGF therapy for CNV and could be followed for more than 1 year were included. METHODS We genotyped a functional single nucleotide polymorphism in the VEGF gene, rs2010963. The associations between the distribution of the rs2010963 genotype and the number of eyes with maintained or improved visual acuity (VA) were analyzed. Furthermore, multivariable logistic regression analysis was performed to adjust for 7 possible prognostic factors, including age, sex, CNV size, CNV location, administration of loading dose, pretreatment VA, and number of additional treatments. MAIN OUTCOME MEASURES The primary end point was maintenance of VA, and secondary end points were progression of chorioretinal atrophy (CRA) and recurrence of CNV. RESULTS Mean age and mean axial length were not significantly different among 3 genotypes of rs2010963. The percentage of eyes with maintained or improved VA was significantly higher with the G allele of rs2010963 (P =0.016), and stepwise analysis revealed that both rs2010963 and CNV size were associated with VA maintenance (P =0.040 and 0.033, respectively). The secondary analysis revealed that administration of a loading dose was significantly associated with both CRA progression (P =0.031) and recurrence of CNV (P =0.020), whereas rs2010963 was not. CONCLUSIONS These results suggest that the VEGF polymorphism influences the VA prognosis in highly myopic eyes with CNV within 1 year after anti-VEGF treatment. This association was still observed after removing its confounding effect through CNV size. The rs2010963 polymorphism was not associated with CNV recurrence or CRA progression, which indicates that these changes are not tied to intrinsic factors and may be controllable by improving treatment methods.
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Affiliation(s)
- Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan; Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Yumiko Akagi-Kurashige
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan; Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kyoko Kumagai
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Isao Nakata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan; Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideo Nakanishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan; Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Oishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryo Yamada
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nagahisa Yoshimura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Voykov B, Ziemssen F, Bartz-Schmidt KU. [Therapy of myopic choroidal neovascularization]. Ophthalmologe 2012; 109:766-9. [PMID: 22828745 DOI: 10.1007/s00347-011-2500-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Recently published studies have shown that myopic choroidal neovascularization (mCNV) is efficiently treated by anti-vascular endothelial growth factor (VEGF) drugs. Within a prospective executive study, photodynamic therapy failed to prove a significant difference over the duration of 2 years. Although a systematic evaluation of different retreatment algorithms still has to be done the administration of single injections depending on specialist assessment of morphological changes, predominantly spectral domain optical coherence tomography (SD-OCT) and fundus, has achieved a marked visual improvement. The experience of treating age-related macular degeneration should not be simply transferred to mCNV and an individual approach, not only for female patients of childbearing age, is necessary.
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Affiliation(s)
- B Voykov
- Department für Augenheilkunde, Universität Tübingen, Schleichstrasse 12-16, Tübingen, Germany.
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Long-term outcome of intravitreal anti-vascular endothelial growth factor therapy with bevacizumab or ranibizumab as primary treatment for subfoveal myopic choroidal neovascularization. Eye (Lond) 2012; 26:1004-11. [PMID: 22595908 DOI: 10.1038/eye.2012.97] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the long-term efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy as primary treatment for subfoveal myopic choroidal neovascularization (CNV). METHODS In all, 37 treatment-naïve eyes of 37 patients with subfoveal myopic CNV who received intravitreal bevacizumab (n=22) or ranibizumab (n=15) injections with at least 2 years of follow-up were reviewed. All eyes received initial three loading doses of anti-VEGF at monthly intervals and retreatment was performed in persistent or recurrent CNV. Multivariate regression analyses were performed to determine the prognostic factors for visual outcome. RESULTS The mean age was 57.3 years and the mean refractive error was -11.7 D. For all eyes, the mean logMAR best-corrected visual acuity improved from 0.86 (20/145) at baseline to 0.48 (20/60) at 2 years (P<0.001). The mean visual improvement for the bevacizumab and ranibizumab groups at 2 years was 2.8 and 5.1 lines, respectively (P=0.073). There was no significant difference in the proportion of eyes having visual gain of three or more lines or visual loss of three or more lines between the two groups. The mean number of injections was 3.8 for both bevacizumab and ranibizumab groups. Multivariate analyses showed that eyes with higher myopic refractive error were less likely to have visual gain after treatment (P=0.043), while size of CNV was negatively correlated with mean change in vision (P=0.046). CONCLUSIONS Intravitreal anti-VEGF therapy resulted in long-term visual improvement in myopic CNV. The treatment efficacy in terms of visual gain and number of retreatment appeared to be similar between bevacizumab and ranibizumab.
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Oishi A, Yamashiro K, Tsujikawa A, Ooto S, Tamura H, Nakata I, Miyake M, Yoshimura N. Long-term effect of intravitreal injection of anti-VEGF agent for visual acuity and chorioretinal atrophy progression in myopic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol 2012; 251:1-7. [DOI: 10.1007/s00417-012-2022-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/23/2012] [Accepted: 03/26/2012] [Indexed: 02/07/2023] Open
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