Abstract and Introduction
Abstract
Objective To report the visual outcome after 4-year follow-up in a series of highly myopic eyes with choroidal neovascularisation (CNV) treated with antivascular endothelial growth factor (anti-VEGF) drugs.
Methods A retrospective, non-randomised, multicentre, consecutive, interventional case series study was performed. 92 highly myopic eyes with subfoveal CNV were treated with intravitreal injection (IVI) of anti-VEGF. The initial protocol (1 vs 3 injections) was dictated by surgeons' preferences and followed by an as-needed monthly regime. Best-corrected visual acuity (BCVA) was evaluated at baseline and then monthly. The primary aim was to analyse BCVA changes. The effect of age, spherical equivalent (SE) and treating drug were evaluated as secondary objectives.
Results The mean age of the patients was 57 years (SD 14, range 30–93). The mean number of letters read was 46.1 (SD 16.8, range 5–70) at baseline, 55.5 (SD 18.6, range 10–85) at 12 months, 50.1 (SD 20.1, range 5–82) at 24 months, 54.2 (SD 21.9, range 2–85) at 36 months and 53.1 (SD 22.5, range 1–83) at 48 months (p=0.000, initial vs 12, 24 and 36 months; p=0.01 initial vs 48 months; Student t test for paired data). The mean total number of IVI was 4.9 (SD 5.4, range 1–29). SE and treating drug had no influence on the final visual outcome and number of injections required.
Conclusions Intravitreal bevacizumab and ranibizumab are effective therapies and show similar clinical effects in highly myopic CNV. Visual acuity gain is maintained at 4-year follow-up.
Introduction
The standard care for myopic choroidal neovascularisation (CNV) is photodynamic therapy with verteporfin (PDT). Antivascular endothelial growth factor (anti-VEGF) drugs such as ranibizumab and bevacizumab have been used off-label to treat CNV secondary to high myopia with good results. Several studies have reported on the outcome of intravitreal bevacizumab (IVB) in the short term at 1 and 2 years follow-up, and intravitreal ranibizumab (IVR) at 2 years. More recently, Hefner and Peiretti reported on their results with IVR and IVB at 3 and 4 years, respectively. The initial therapeutic protocol has consisted of 3-monthly consecutive injections or one single injection. The results of three versus one loading dose have been published. The outcomes of PDT and IVB to treat myopic CNV have been compared, suggesting that bevacizumab is more effective than PDT.
The purpose of this study is to evaluate the visual acuity changes during a 4-year follow-up period in a large series of highly myopic eyes with CNV treated with anti-VEGF drugs.