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Ng DSC, Chan LKY, Lai TYY. Myopic macular diseases: A review. Clin Exp Ophthalmol 2023; 51:229-242. [PMID: 36594934 DOI: 10.1111/ceo.14200] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/05/2022] [Accepted: 12/16/2022] [Indexed: 01/04/2023]
Abstract
Recent evidence has demonstrated that the global public health burden of myopia is rising rapidly. Highly myopic eyes are associated with increased frequency of eye disorders that can lead to irreversible visual impairment. With recent technological advancement in ophthalmic imaging modalities, various macular complications associated with pathologic myopia are being elucidated. The development and progression of myopic chorioretinal atrophy, myopic macular neovascularization, myopic traction maculopathy and dome-shaped macula are vision-threatening myopic macular diseases. In order to overcome the challenges in managing patients with pathologic myopia, it is important to have a complete understanding in the natural course of these myopic macular diseases. Standardising the classification criteria of pathologic myopia is essential for enhancing clinical surveillance. Personalised pharmaceutical therapy and surgical interventions will help to optimise the treatment outcomes in patients suffering from these myopic macular diseases.
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Affiliation(s)
- Danny S C Ng
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong.,Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Leo K Y Chan
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong.,Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong.,2010 Retina & Macula Centre, Hong Kong, Hong Kong
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2
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Chen J, Zhou J, Peng Y, Xie Y, Xiao Y. Aptamers: A prospective tool for infectious diseases diagnosis. J Clin Lab Anal 2022; 36:e24725. [PMID: 36245423 PMCID: PMC9701868 DOI: 10.1002/jcla.24725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 12/05/2022] Open
Abstract
It is well known that people's health is seriously threatened by various pathogens (such as Mycobacterium tuberculosis, Treponema pallidum, Novel coronavirus, HIV, Mucor, etc.), which leads to heavy socioeconomic burdens. Therefore, early and accurate pathogen diagnosis is essential for timely and effective therapies. Up to now, diagnosing human contagious diseases at molecule and nano levels is remarkably difficult owing to insufficient valid probes when it comes to determining the biological markers of pathogens. Aptamers are a set of high‐specificity and high‐sensitivity plastic oligonucleotides screened in vitro via the selective expansion of ligands by exponential enrichment (SELEX). With the advent of aptamer‐based technologies, their merits have aroused mounting academic interest. In recent years, as new detection and treatment tools, nucleic acid aptamers have been extensively utilized in the field of biomedicine, such as pathogen detection, new drug development, clinical diagnosis, nanotechnology, etc. However, the traditional SELEX method is cumbersome and has a long screening cycle, and it takes several months to screen out aptamers with high specificity. With the persistent development of SELEX‐based aptamer screening technologies, the application scenarios of aptamers have become more and more extensive. The present research briefly reviews the research progress of nucleic acid aptamers in the field of biomedicine, especially in the diagnosis of contagious diseases.
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Affiliation(s)
- Jiayi Chen
- Department of Clinical Laboratory, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jiahuan Zhou
- Department of Clinical Laboratory, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yunchi Peng
- Department of Clinical Laboratory, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yafeng Xie
- Department of Clinical Laboratory, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yongjian Xiao
- Department of Clinical Laboratory, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
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Karasu B, Celebi ARC. The efficacy of different anti-vascular endothelial growth factor agents and prognostic biomarkers in monitoring of the treatment for myopic choroidal neovascularization. Int Ophthalmol 2022; 42:2729-2740. [PMID: 35357641 DOI: 10.1007/s10792-022-02261-1] [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: 06/19/2021] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate anatomical and visual results of eyes with naive myopic choroidal neovascularization (mCNV) in patients treated with intravitreal anti-vascular endothelial growth factor (VEGF) therapies. MATERIAL AND METHODS This is a retrospective, non-randomized, comperative, intervetional study. One hundred fourteen eyes of 114 patients with mCNV who underwent intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR) or intravitreal aflibercept (IVA) monotherapy injections were enrolled into the study. The best corrected visual acuity (BCVA), central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) were compared among the groups during the follow-up periods at the beginning, months 1, 3, 6, 12, and the final visit. RESULTS The mean age of the patients was 47.76 ± 10.57 years (range, 33-72 years) and the mean follow-up period was 23.34 ± 6.81 months (range, 13-38 months). The mean BCVA denoted a significantly improve at each group (p < 0.05). In terms of an inter-group analysis of all 3 groups, at months 1, 6, and 12 and final visit, the BCVA were statistically significantly better in the IVA group when compared to both IVB and IVR groups (p = 0.021, p = 0.032, p = 0.024, p = 0.012). There was a significant decrease in CMT following IVB (236.49 ± 40.91 μm-190.74 ± 50.12 μm), IVA (232.91 ± 46.29 μm-193.73 ± 46.81 μm) and IVR (234.78 ± 45.37 μm-192.21 ± 37.27 μm) between baseline and final visit (p = 0.018, p = 0.002, p < 0.001, respectively). There was a statistically significant decrease in SFCT values between baseline and final examination only in the IVA group (p < 0.001). The mean number of injections were 9.18 ± 3.18 (range; 3 to 13) in IVB, 6.46 ± 2.93 (range; 3-11) in IVR and 4.45 ± 1.42 (range; 2-7) in IVA (p = 0.028). CONCLUSION All three anti-VEGFs were found to be effective in terms of visual results in patients with mCNV. However, we demonstrated that IVA reduces the need for anti-VEGF when compared to patients who received both IVB and IVR. Furthermore, IVA induced a prominent reduction in SFCT, whereas IVR and IVB did not have a significant action on SFCT.
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Affiliation(s)
- Buğra Karasu
- Department of Ophthalmology, Tuzla State Hospital, İçmeler Mahallesi, Piri Reis Caddesi, No: 74 Tuzla/İstanbul, 34947, Istanbul, Turkey. .,Department of Ophthalmology, Beyoglu Eye Research and Training Hospital, Istanbul, Turkey.
| | - Ali Rıza Cenk Celebi
- Department of Ophthalmology Istanbul, School of Medicine, Acibadem University, Istanbul, Turkey
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Chen C, Yan M, Huang Z, Song YP. The Evaluation of a Two-Year Outcome of Intravitreal Conbercept versus Ranibizumab for Pathological Myopic Choroidal Neovascularization. Curr Eye Res 2020; 45:1415-1421. [PMID: 32191134 DOI: 10.1080/02713683.2020.1742357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Aim: The aim of this study was to evaluate and compare the 24-month follow-up results of intravitreal conbercept with ranibizumab in the treatment of choroidal neovascularization (CNV), secondary to pathological myopia (PM). Methods: Fifty-nine patients' 64 eyes with pathological myopic CNV were retrospectively reviewed. Thirty-one eyes underwent conbercept treatment (group C) and 33 eyes underwent ranibizumab treatment (group R), respectively. No patients have received any treatment before. The main outcome of the best-corrected visual acuity (BCVA) uses an international standard visual acuity chart and is converted to the minimum resolution logarithm (LogMAR) visual acuity. Results: There were no significant differences between the two groups at the baseline statisticlly. At 24 months, the mean logMAR BCVA of group C increased from 0.95 ± 0.54 to 0.58 ± 0.39 (P < .001) and the mean central macular thickness (CMT) decreased from 280.97 ± 62.69 μm to 242.35 ± 90.39 μm (P = .033). The mean logMAR BCVA of group R increased from 0.86 ± 0.40 to 0.54 ± 0.28 (P < .001) and the mean CMT was reduced from 303.58 ± 61.95 μm to 251.82 ± 84.74 μm (P = .005). There was no significant difference in logMAR BCVA and CMT between the two groups (P = .962, P = .667, respectively). The mean number of injections was 3.94 ± 1.88 in group C and 4.06 ± 1.82 in group R (P = .788). During the follow-up period, no ocular complications and systemic adverse reactions were observed. Conclusion: Similar visual acuity and improved morphology were achieved in both groups. The two drugs were also found to be safe and effective in the treatment of pathological myopic CNV.
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Affiliation(s)
- Cong Chen
- The First School of Clinical Medicine, Southern Medical University , Guangzhou, China.,Department of Ophthalmology, General Hospital of Central Theater Command , Wuhan, China
| | - Ming Yan
- Department of Ophthalmology, General Hospital of Central Theater Command , Wuhan, China
| | - Zhen Huang
- Department of Ophthalmology, General Hospital of Central Theater Command , Wuhan, China
| | - Yan-Ping Song
- The First School of Clinical Medicine, Southern Medical University , Guangzhou, China.,Department of Ophthalmology, General Hospital of Central Theater Command , Wuhan, China
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Milani P, Pellegrini M, Massacesi A, Scotti F, Moschini S, Setaccioli M, Secondi R, Bergamini F. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FEATURES OF SUBRETINAL FIBROSIS AFTER MYOPIC NEOVASCULARIZATION. Retina 2020; 40:249-256. [PMID: 31972794 DOI: 10.1097/iae.0000000000002388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the optical coherence tomography (OCT) angiography features of subretinal fibrosis in eyes with myopic choroidal neovascularization after natural evolution or secondary to intravitreal anti-vascular endothelial growth factor therapy. METHODS Retrospective observational case series. All eyes underwent a multimodal imaging examination including fluorescein angiography, spectral domain OCT, OCT angiography, and en face OCT. RESULTS Twenty-five eyes of 25 patients with mean age of 56.4 ± 14.9 were included in the study. Subretinal fibrosis was diagnosed at mean 30 (range 6-116) months before inclusion. Within the subretinal fibrosis, an abnormal vascular network was observed in 20/25 (80%) eyes, located typically in the outer retina (18/20, 90%) or the choriocapillaris (14/20, 70%) segmentation. The most prevalent patterns were "round tangle" and "tapered tangle." On en face OCT, the subretinal fibrosis was evidenced in 24/25 (96%) eyes, most prevalently in the outer retina (21/25, 84%) and in the choriocapillaris (18/25, 72%), where main feature was white-hyperreflective (20/21, 95%) and dark-hyporeflective (17/18, 94%) appearance, respectively. The presence of subretinal fibrosis on en face OCT was positively correlated with the presence of abnormal vascular network on OCT angiography in 61% of the cases (P = 0.005). CONCLUSION Subretinal fibrosis secondary to myopic choroidal neovascularization frequently contains blood flow within a persistent abnormal vascular network as assessed by OCT angiography.
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Affiliation(s)
- Paolo Milani
- Ophthalmology Department, IRCCS Istituto Auxologico Italiano, Milan, Italy; and
| | - Marco Pellegrini
- Ophthalmology Department, IRCCS Istituto Auxologico Italiano, Milan, Italy; and
- Department of Clinical Sciences, Eye Clinic, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Amedeo Massacesi
- Ophthalmology Department, IRCCS Istituto Auxologico Italiano, Milan, Italy; and
| | - Fabrizio Scotti
- Ophthalmology Department, IRCCS Istituto Auxologico Italiano, Milan, Italy; and
| | - Stefania Moschini
- Ophthalmology Department, IRCCS Istituto Auxologico Italiano, Milan, Italy; and
| | - Marco Setaccioli
- Ophthalmology Department, IRCCS Istituto Auxologico Italiano, Milan, Italy; and
| | - Roberta Secondi
- Ophthalmology Department, IRCCS Istituto Auxologico Italiano, Milan, Italy; and
| | - Fulvio Bergamini
- Ophthalmology Department, IRCCS Istituto Auxologico Italiano, Milan, Italy; and
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Nikkhah H, Karimi S, Ahmadieh H, Azarmina M, Abrishami M, Ahoor H, Alizadeh Y, Behboudi H, Daftarian N, Dehghan MH, Entezari M, Farrahi F, Ghanbari H, Falavarjani KG, Javadi MA, Karkhaneh R, Moradian S, Manaviat MR, Mehryar M, Nourinia R, Parvaresh MM, Ramezani A, Haghi AR, Riazi-Esfahani M, Soheilian M, Shahsavari M, Shahriari HA, Rajavi Z, Safi S, Shirvani A, Rahmani S, Sabbaghi H, Pakbin M, Kheiri B, Ziaei H. Intravitreal Injection of Anti-vascular Endothelial Growth Factor Agents for Ocular Vascular Diseases: Clinical Practice Guideline. J Ophthalmic Vis Res 2018; 13:158-169. [PMID: 29719645 PMCID: PMC5905310 DOI: 10.4103/jovr.jovr_50_18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 12/17/2017] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy. METHODS Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations. RESULTS All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases. CONCLUSION The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients.
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Affiliation(s)
- Homayoun Nikkhah
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Karimi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Azarmina
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Abrishami
- Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Ahoor
- Department of Ophthalmology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yousef Alizadeh
- Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran
| | - Hasan Behboudi
- Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran
| | - Narsis Daftarian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Dehghan
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Entezari
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereydoun Farrahi
- Department of Ophthalmology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Karkhaneh
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Moradian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Reza Manaviat
- Department of Ophthalmology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Morsal Mehryar
- Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Nourinia
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Parvaresh
- Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Ramezani
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Riazi-Esfahani
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Soheilian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Shahsavari
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein-Ali Shahriari
- Department of Ophthalmology, Al-Zahra Eye Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zhale Rajavi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sare Safi
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Shirvani
- Standardization and CPG Development Office, Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | - Saeed Rahmani
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Sabbaghi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojgan Pakbin
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Ziaei
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ng DSC, Lai TYY, Cheung CMG, Ohno-Matsui K. Anti-Vascular Endothelial Growth Factor Therapy for Myopic Choroidal Neovascularization. Asia Pac J Ophthalmol (Phila) 2017; 6:554-560. [PMID: 29057641 DOI: 10.22608/apo.2017308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Myopic choroidal neovascularization (CNV) is one of the most vision-impairing complications in patients with pathologic myopia. It is also one of the most frequently encountered non.age-related macular degeneration causes of CNV and affects young patients in the working age group. Fluorescein angiography (FA) and spectral domain optical coherence tomography (OCT) are generally indicated to confirm the diagnosis of active myopic CNV before initiation of treatment. Without treatment, natural history studies have shown that the vision outcome can be very poor. More recently, a number of retrospective, prospective and phase 3, multicenter, randomized controlled trials have established the safety and efficacy of intravitreal anti.vascular endothelial growth factor (VEGF) agents for the treatment of myopic CNV. Long-term follow-up studies have found that some of the initial vision gained after intravitreal anti-VEGF therapy may not be maintained, owing to the presence and progression of chorioretinal atrophy (CRA) adjacent to the CNV. Further research on clinical and imaging characteristics may elucidate the prognostic factors that are crucial to optimizing the treatment and prevention of visual impairment associated with myopic CNV.
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Affiliation(s)
- Danny S C Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- 2010 Retina and Macula Centre, Hong Kong
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke NUS Medical School, National University of Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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8
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Is ellipsoid zone integrity essential for visual recovery in myopic neovascularization after anti-VEGF therapy? Graefes Arch Clin Exp Ophthalmol 2017; 255:1713-1720. [DOI: 10.1007/s00417-017-3706-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/15/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022] Open
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9
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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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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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12
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Ng DSC, Brelén ME, Tong JMK, Kwok AKH. Spectral-Domain Optical Coherence Tomography of Subretinal Hyperreflective Exudation in Myopic Choroidal Neovascularization. Am J Ophthalmol 2015; 160:1313-4. [PMID: 26422830 DOI: 10.1016/j.ajo.2015.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 08/25/2015] [Accepted: 09/08/2015] [Indexed: 11/27/2022]
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The other CNVM: A review of myopic choroidal neovascularization treatment in the age of anti-vascular endothelial growth factor agents. Surv Ophthalmol 2015; 60:204-15. [DOI: 10.1016/j.survophthal.2014.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 10/14/2014] [Accepted: 10/31/2014] [Indexed: 01/20/2023]
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Kung YH, Wu TT, Huang YH. One-year outcome of two different initial dosing regimens of intravitreal ranibizumab for myopic choroidal neovascularization. Acta Ophthalmol 2014; 92:e615-20. [PMID: 24924911 DOI: 10.1111/aos.12457] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 05/01/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate and compare the 12-month outcomes of two different initial dosing regimens of intravitreal ranibizumab for myopic choroidal neovascularization (CNV). METHODS We retrospectively reviewed the medical records of 46 consecutive, treatment-naive eyes which received intravitreal ranibizumab for subfoveal and juxtafoveal CNV secondary to pathologic myopia with a follow-up of 12 months. Two groups were created according to different initial dosing regimens: group 1 included 25 eyes treated by a single intravitreal injection; group 2 included 21 eyes treated by three consecutive monthly injections. Additional injections were performed if needed. Patients' demographic data, best-corrected visual acuity (BCVA), recurrence of CNV and total number of treatments were recorded and evaluated. RESULTS There was no significant difference between two groups among baseline demographic data. At 12 months, the mean logMAR BCVA improved from 0.58 to 0.23 in group 1 and from 0.55 to 0.22 in group 2 (both p < 0.001; Wilcoxon signed-rank test). The mean logMAR BCVA at 12 months did not differ significantly. The average number of injections was 2.32 (SD 1.22) in group 1 and 3.57 (SD 1.12) in group 2 (p = 0.001; two-tailed t-test). During the follow-up, 17 of 25 eyes in group 1 and 5 of 21 eyes in group 2 received additional injections (p = 0.004). CONCLUSIONS Similar visual improvement was achieved in both groups. Although the eyes with a loading dose of 3 monthly injections required a higher number of total injections over 1 year, there was a much lower rate of retreatment needed.
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Affiliation(s)
- Ya-Hsin Kung
- Department of Ophthalmology; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Tsung-Tien Wu
- Department of Ophthalmology; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Ya-Hui Huang
- Department of Ophthalmology; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
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Hashemi S, Faramarzi MA, Ghasemi Falavarjani K, Abdollahi M. Bevacizumab for choroidal neovascularization secondary to age-related macular degeneration and pathological myopia. Expert Opin Biol Ther 2014; 14:1837-48. [DOI: 10.1517/14712598.2014.967210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Loutfi M, Siddiqui M, Dhedhi A, Kamal A. A systematic review and meta-analysis comparing intravitreal ranibizumab with bevacizumab for the treatment of myopic choroidal neovascularisation. Saudi J Ophthalmol 2014; 29:147-55. [PMID: 25892935 PMCID: PMC4398811 DOI: 10.1016/j.sjopt.2014.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 07/06/2014] [Accepted: 09/15/2014] [Indexed: 11/23/2022] Open
Abstract
Intravitreal injections of ranibizumab (IVR) and bevacizumab (IVB) have both been used as treatments for myopic choroidal neovascularisation. We aimed to produce a meta-analysis of published literature comparing IVR with IVB for the treatment of myopic choroidal neovascularisation, by searching electronic databases from January 1950 to March 2013. Our search produced three suitable studies that reported on 117 patients in total. The results of the meta-analysis demonstrated that the mean number of lines improvement after IVR appeared better compared with IVB [fixed effects model: SMD = 0.46, 95% CI (0.09, 0.83), z = 2.44, p = 0.01]. The number of patients who had a greater than 3 line improvement was similar between groups [fixed effects model: RR = 0.95, 95% CI (0.67, 1.32), z = 0.33, p = 0.74]. At follow up there was no difference in number of those who had an absence of leakage [fixed effects model: RR = 1.04, 95% CI (0.93, 1.16), z = 0.64, p = 0.52]. There was no statistical significance between the two groups in relation to the number of injections [random effects model: SMD = −0.25, 95% CI (−1.12, 0.61), z = 0.57, p = 0.57]. Early evidence therefore suggests that intravitreal injections of ranibizumab are comparable to intravitreal injections of bevacizumab in the treatment of myopic choroidal neovascularisation. Both treatments result in a statistically significant increase in visual acuity with high numbers of patients maintaining stable vision. Further studies are still needed to strengthen results.
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Affiliation(s)
- M. Loutfi
- University of Liverpool Medical School, Liverpool, UK
| | - M.R.S. Siddiqui
- Department of General Surgery, St Heliers Hospital, London, UK
| | - A. Dhedhi
- University of Liverpool Medical School, Liverpool, UK
| | - A. Kamal
- Ophthalmology Department, Aintree University Hospital, Liverpool, UK
- Corresponding author.
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17
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Risk of choroidal neovascularization among the uveitides. Am J Ophthalmol 2013; 156:468-477.e2. [PMID: 23795984 DOI: 10.1016/j.ajo.2013.04.040] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/29/2013] [Accepted: 04/30/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the risk, risk factors, and visual impact of choroidal neovascularization (CNV) in uveitis cases. DESIGN Retrospective cohort study. METHODS Standardized medical record review at 5 tertiary centers. RESULTS Among 15,137 uveitic eyes (8868 patients), CNV was rare in the cases of anterior or intermediate uveitis. Among the 4041 eyes (2307 patients) with posterior uveitis or panuveitis, 81 (2.0%) had CNV at presentation. Risk factors included posterior uveitis in general and specific uveitis syndromes affecting the outer retina-retinal pigment epithelium-choroid interface. Among the 2364 eyes (1357 patients) with posterior uveitis or panuveitis and free of CNV at the time of cohort entry, the cumulative 2-year incidence of CNV was 2.7% (95% confidence interval [CI], 1.8% to 3.5%). Risk factors for incident CNV included currently active inflammation (adjusted hazard ratio [aHR], 2.13; 95% CI, 1.26 to 3.60), preretinal neovascularization (aHR, 3.19; 95% CI, 1.30 to 7.80), and prior diagnosis of CNV in the contralateral eye (aHR, 5.79; 95% CI, 2.77 to 12.09). Among specific syndromes, the incidence was greater in Vogt-Koyanagi-Harada syndrome (aHR, 3.37; 95% CI, 1.52 to 7.46) and punctate inner choroiditis (aHR, 8.67; 95% CI, 2.83 to 26.54). Incident CNV was associated with a 2-line loss of visual acuity (+0.19 logarithm of the minimal angle of resolution units; 95% CI, 0.079 to 0.29) from the preceding visit. CONCLUSIONS CNV is an uncommon complication of uveitis associated with visual impairment that occurs more commonly in forms affecting the outer retina-retinal pigment epithelium-choroid interface, during periods of inflammatory activity, in association with preretinal neovascularization, and in second eyes of patients with unilateral CNV. Because CNV is treatable, a systematic approach to early detection in high-risk patients may be appropriate.
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Tufail A, Patel PJ, Sivaprasad S, Amoaku W, Browning AC, Cole M, Gale R, George S, Lotery AJ, Majid M, McKibbin M, Menon G, Yang Y, Andrews C, Brittain C, Osborne A. Ranibizumab for the treatment of choroidal neovascularisation secondary to pathological myopia: interim analysis of the REPAIR study. Eye (Lond) 2013. [PMID: 23449508 DOI: 10.1038/eye.2014.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIMS To evaluate the efficacy and safety of intravitreal ranibizumab in patients with choroidal neovascularisation secondary to pathological myopia (myopic CNV). Data are from a pre-planned, 6-month interim analysis. METHODS Phase II, open-label, single arm, multicentre, 12-month study, recruiting patients (aged ≥18 years) with active primary or recurrent subfoveal or juxtafoveal myopic CNV, with a best-corrected visual acuity (BCVA) score of 24-78 Early Treatment Diabetic Retinopathy Study (ETDRS) letters in the study eye and a diagnosis of high myopia of at least -6 dioptres. Patients received 0.5 mg ranibizumab administered intravitreally to the study eye, followed by monthly injections given as needed (based on a predefined algorithm) for up to 11 months. RESULTS At 6 months, mean BCVA improved from baseline by 12.2 letters, as did central macular thickness (in this interim analysis defined as a measure of either central subfield macular thickness or centre point macular thickness) from baseline by 108 μm in the 48 study eyes of 48 patients. Fewer patients had centre-involving intraretinal oedema (13.0% vs 91.5%), intraretinal cysts (10.9% vs 57.4%), or subretinal fluid (13.0% vs 66.0%) at 6 months than at baseline. Patients received a mean of 1.9 retreatments, were satisfied with ranibizumab treatment, and well being was maintained. No new safety signals were identified. CONCLUSIONS Results from the planned interim analysis support the role of ranibizumab in the treatment of myopic CNV, with excellent efficacy achieved with a low number of injections and few serious adverse events.
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Affiliation(s)
- A Tufail
- Moorfields Eye Hospital, London, UK.
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Tufail A, Patel PJ, Sivaprasad S, Amoaku W, Browning AC, Cole M, Gale R, George S, Lotery AJ, Majid M, McKibbin M, Menon G, Yang Y, Andrews C, Brittain C, Osborne A. Ranibizumab for the treatment of choroidal neovascularisation secondary to pathological myopia: interim analysis of the REPAIR study. Eye (Lond) 2013; 27:709-15. [PMID: 23449508 DOI: 10.1038/eye.2013.8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIMS To evaluate the efficacy and safety of intravitreal ranibizumab in patients with choroidal neovascularisation secondary to pathological myopia (myopic CNV). Data are from a pre-planned, 6-month interim analysis. METHODS Phase II, open-label, single arm, multicentre, 12-month study, recruiting patients (aged ≥18 years) with active primary or recurrent subfoveal or juxtafoveal myopic CNV, with a best-corrected visual acuity (BCVA) score of 24-78 Early Treatment Diabetic Retinopathy Study (ETDRS) letters in the study eye and a diagnosis of high myopia of at least -6 dioptres. Patients received 0.5 mg ranibizumab administered intravitreally to the study eye, followed by monthly injections given as needed (based on a predefined algorithm) for up to 11 months. RESULTS At 6 months, mean BCVA improved from baseline by 12.2 letters, as did central macular thickness (in this interim analysis defined as a measure of either central subfield macular thickness or centre point macular thickness) from baseline by 108 μm in the 48 study eyes of 48 patients. Fewer patients had centre-involving intraretinal oedema (13.0% vs 91.5%), intraretinal cysts (10.9% vs 57.4%), or subretinal fluid (13.0% vs 66.0%) at 6 months than at baseline. Patients received a mean of 1.9 retreatments, were satisfied with ranibizumab treatment, and well being was maintained. No new safety signals were identified. CONCLUSIONS Results from the planned interim analysis support the role of ranibizumab in the treatment of myopic CNV, with excellent efficacy achieved with a low number of injections and few serious adverse events.
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Affiliation(s)
- A Tufail
- Moorfields Eye Hospital, London, UK.
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Inhoffen W, Ziemssen F. [Morphological features of myopic choroidal neovascularization: differences to neovascular age-related macular degeneration]. Ophthalmologe 2013; 109:749-57. [PMID: 22911352 DOI: 10.1007/s00347-011-2498-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Choroidal neovascularization due to pathological myopia (mCNV) differs in important characteristics from lesions seen in age-related macular degeneration (ARMD). Myopic CNV is associated with typical phenomena, such as lacquer cracks or patchy atrophy drusen or pigment epithelium detachment are rare occurrences. The dimensions of mCNV and the extent of leakage are substantially smaller. The heterogeneous combination of thinning and concomitant staphyloma often complicates the early detection of neovascular lesions. Diagnosis and evaluation of the clinical progress are only possible using the combination of different imaging modalities, e.g. funduscopy, fluorescein angiography (FLA) and spectral domain optical coherence tomography (SD-OCT). Special forms, such as periconal mCNV or dome-shaped variants exhibit a typical progression and response to therapy. In the course of the disease a progressive pigmentation and secondary atrophy occur and later, depigmentation of the mCNV complicates the demarcation of the original mCNV within the zone of atrophy. Extensive information and counselling seem to be mandatory in order to allow a better self-assessment. Sometimes, patients notice the first symptoms of recurrent mCNV activity before confirmation is possible by objective diagnostics.
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Affiliation(s)
- W Inhoffen
- Department für Augenheilkunde, Universität Tübingen, Schleichstrasse 12-16, Tübingen, Germany.
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Milani P, Massacesi A, Ciaccia S, Setaccioli M, Moschini S, Bergamini F. Only first intravitreal bevacizumab injection achieves statistically significant visual improvement in naïve myopic choroidal neovascularization. Clin Ophthalmol 2012. [PMID: 23204830 PMCID: PMC3508741 DOI: 10.2147/opth.s34649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background The aim of this study was to evaluate the efficacy of intravitreal bevacizumab when administered on an as-needed basis for the treatment of myopic choroidal neovascularization (CNV), and to assess visual changes upon treatment. Methods This study was designed as a retrospective, interventional case series, for which the inclusion criteria were pathologic myopia, and documentation of untreated active macular CNV on fluorescein angiography and optical coherence tomography. Monthly changes in best-corrected visual acuity (BCVA), visual gain after each treatment, and correlation with refraction, age, location, and dimension of CNV were considered. The data were analyzed using the one-tailed, paired Wilcoxon test. Results Nineteen naive eyes were found suitable for the study. The mean number of treatments was 3.32 ± 2.36 (confidence interval 2.25–4.37) during a mean follow-up period of 18.95 ± 8.3 months. At baseline, mean BCVA was 0.58 ± 0.37 logarithm of the minimum angle of resolution (logMAR) units. At 12 months, mean BCVA was 0.39 ± 0.35 logMAR and at 24 months was 0.39 ± 0.40. Mean improvement in BCVA from baseline was +0.17 ± 0.25 logMAR (P < 0.05) at month 12, +0.14 ± 0.25 logMAR (P = 0.1) at month 18, and +0.09 ± 0.32 logMAR (P = 0.5) at month 24. Improvement on pretreatment BCVA was significant (+0.16 logMAR, P < 0.01) after the first injection, but not after the second (−0.01 logMAR, P = 0.5) or third (+0.02 logMAR, P = 0.5) injections. There was a statistically significant correlation between age and number of treatments, and between improvement in BCVA of foveal versus extrafoveal location of CNV. Conclusion The use of intravitreal bevacizumab “as needed” is an effective treatment for myopic CNV, but visual gain is statistically significant only after the first injection and decreases in the second year.
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Affiliation(s)
- Paolo Milani
- Dipartimento di Oculistica, Istituto Auxologico Italiano, Milano, Italy
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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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Silva R. Myopic Maculopathy: A Review. Ophthalmologica 2012; 228:197-213. [DOI: 10.1159/000339893] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 05/27/2012] [Indexed: 11/19/2022]
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