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Wang J, Kunikata H, Yasuda M, Himori N, Nitta F, Nakazawa T. Systemic Oxidative Stress Level as a Pathological and Prognostic Factor in Myopic Choroidal Neovascularization. OPHTHALMOLOGY SCIENCE 2024; 4:100550. [PMID: 39100756 PMCID: PMC11293568 DOI: 10.1016/j.xops.2024.100550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/18/2024] [Accepted: 04/29/2024] [Indexed: 08/06/2024]
Abstract
Purpose To investigate the association of systemic oxidative stress level with myopic choroidal neovascularization (mCNV) and its clinical outcomes. Design Retrospective case-control study. Participants This retrospective study included 52 eyes of 52 healthy participants (mean age: 62.5 years), 30 eyes of 30 patients (mean age: 59.6 years) with high myopia (HM) but without mCNV, and 23 eyes of 23 patients (mean age: 61.8 years) with HM and mCNV who received intravitreal anti-VEGF antibody injections (IVIs) using a pro re nata regimen during the 6-month follow-up after the first IVI. Methods Clinical findings, including oxidative stress parameters, such as diacron reactive oxygen metabolites (dROMs), biological antioxidant potential (BAP), and the BAP/dROM ratio (B/d ratio), were analyzed. Main Outcome Measures Clinical features and oxidative stress parameters. Results Both BAP and the B/d ratio were significantly lower in the HM/mCNV group than in the HM/no mCNV group (P = 0.002 and P = 0.012, respectively) and than in the control group (P = 0.001 and P = 0.026, respectively). In a multiple logistic regression analysis, axial length (odds ratio 1.878, P = 0.042) and the B/d ratio (odds ratio 0.470, P = 0.026) were significantly associated with mCNV. Dividing the patients into high and low B/d ratio groups (with a cutoff of 5.2) showed that subfoveal choroidal thickness (SFCT) was lower (P = 0.002) and the number of IVI treatments was higher (P = 0.029) in the low B/d ratio group than in the high B/d ratio group. In multiple regression analyses, only the B/d ratio was significantly associated with SFCT (β = 0.684, P = 0.006). Conclusions The oxidative stress level in eyes with HM differed according to mCNV, SFCT, and the number of IVI treatments. Measuring oxidative stress parameters might be useful in eyes with HM both for assessing the risk of developing mCNV and determining disease activity. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Jiying Wang
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masayuki Yasuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Noriko Himori
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Fumihiko Nitta
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Glachs L, Embacher S, Berghold A, Wildner B, Michelitsch M, Tscherne A, Wedrich A, Posch-Pertl L. Treatment of myopic choroidal neovascularization: a network meta-analysis and review. Graefes Arch Clin Exp Ophthalmol 2024; 262:1693-1722. [PMID: 37950753 PMCID: PMC11106160 DOI: 10.1007/s00417-023-06271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 06/19/2023] [Accepted: 10/07/2023] [Indexed: 11/13/2023] Open
Abstract
PURPOSE This is, to our knowledge, the first network meta-analysis aiming to compare all treatment modalities for myopic choroidal neovascularization (CNV). METHODS After the electronic databases were searched, two independent reviewers screened titles, abstracts, full-texts, and extracted information. Primary endpoints were change in visual outcome and central retinal thickness. We used a network meta-analysis to compare treatment outcomes in the early (≤ 6 months) and late (> 6 months) phase. RESULTS We included 34 studies (2,098 eyes) in our network meta-analysis. In the early phase, the use of anti-VEGF led to a gain of 14.1 letters (95% CI, 10.8-17.4) compared to untreated patients (p < 0.0001), 12.1 letters (95% CI, 8.3-15.8) to photodynamic therapy (PDT) (p < 0.0001), 7.5 (95% CI, 1.2-13.8) letters to intravitreal triamcinolone acetonide (TCA) (p = 0.019), and - 2.9 letters (95% CI, - 6.0-0.2) to the combination of anti-VEGF and PDT (p = 0.065). In the later phase, these results were largely maintained. There were no significant differences in visual outcomes between patients treated with 1 + PRN and 3 + PRN. However, the 1 + PRN group received 1.8 (SD 1.3), while the 3 + PRN group received 3.2 (SD 0.9) injections within 12 months (p < 0.0001). CONCLUSION This network meta-analysis confirms that anti-VEGF is the most effective treatment for myopic CNV using the 1 + PRN treatment strategy.
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Affiliation(s)
- Laura Glachs
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Stefan Embacher
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Brigitte Wildner
- University Library, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Monja Michelitsch
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Anna Tscherne
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Andreas Wedrich
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Laura Posch-Pertl
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria.
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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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Toto L, Di Antonio L, Costantino O, Mastropasqua R. Anti-VEGF Therapy in Myopic CNV. Curr Drug Targets 2021; 22:1054-1063. [PMID: 33511955 DOI: 10.2174/1389450122999210128180725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/30/2020] [Accepted: 11/17/2020] [Indexed: 11/22/2022]
Abstract
In this narrative-review, we report the most recent data from the literature of anti-vascular endothelial growth factor treatment for myopic choroidal neovascularization (mCNV). Myopic CNV is the most frequent sight-threatening complication of pathologic myopia. The natural course of mCNV can result in expanding macular atrophy and /or fibrosis, leading to irreversible visual loss after 5 years. Retinal multimodal imaging is mandatory for early diagnosis and monitoring of the disease during treatment. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is recommended as the first-line treatment option for mCNV. Prompt treatment of active mCNV with intravitreal anti-VEGF therapy has been demonstrated to be effective in terms of visual outcome improvements reducing the occurrence of late-stage complications.
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Affiliation(s)
- Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, via dei Vestini 31, 66100, Italy
| | - Luca Di Antonio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, via dei Vestini 31, 66100, Italy
| | - Olivia Costantino
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, via dei Vestini 31, 66100, Italy
| | - Rodolfo Mastropasqua
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
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Abstract
BACKGROUND Myopic choroidal neovascularization (CNV) is a common cause of central visual loss in patients with high myopia, and the most common form of CNV in younger individuals. Pharmacologic therapy is the current mainstay of treatment of these patients. METHODS Review of pharmacological treatment options for myopic CNV, which primarily involves intravitreal administration of anti-vascular endothelial growth factor (anti-VEGF) agents. RESULTS At this time, anti-VEGF therapy agents are the first-line therapy in these patients. Comparative trials have not identified any major differences in treatment outcomes between aflibercept, bevacizumab, and ranibizumab. Only ranibizumab is approved for this indication in the US. Best visual outcomes are associated with younger age, smaller lesion size, and absence of chorioretinal atrophy. CONCLUSION Anti-VEGF therapy is generally very effective in the treatment of myopic CNV.
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Affiliation(s)
- Hacer Isildak
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Stephen G Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
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Li S, Ding X, Sun L, Zhao X, Zhang A, Lyu C, Liu B, Zhang J, Jin C, Lu L. Two different initial treatment regimens of ranibizumab in myopic choroidal neovascularization: 12‐month results from a randomized controlled study. Clin Exp Ophthalmol 2018; 47:250-258. [DOI: 10.1111/ceo.13424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/22/2018] [Accepted: 09/25/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Songshan Li
- State Key Laboratory of Ophthalmology, Retina DivisionZhongshan Ophthalmic Center, Sun Yat‐sen University Guangzhou China
| | - Xiaoyan Ding
- State Key Laboratory of Ophthalmology, Retina DivisionZhongshan Ophthalmic Center, Sun Yat‐sen University Guangzhou China
| | - Limei Sun
- State Key Laboratory of Ophthalmology, Retina DivisionZhongshan Ophthalmic Center, Sun Yat‐sen University Guangzhou China
| | - Xiujuan Zhao
- State Key Laboratory of Ophthalmology, Retina DivisionZhongshan Ophthalmic Center, Sun Yat‐sen University Guangzhou China
| | - Aiyuan Zhang
- State Key Laboratory of Ophthalmology, Retina DivisionZhongshan Ophthalmic Center, Sun Yat‐sen University Guangzhou China
| | - Cancan Lyu
- State Key Laboratory of Ophthalmology, Retina DivisionZhongshan Ophthalmic Center, Sun Yat‐sen University Guangzhou China
| | - Bingqian Liu
- State Key Laboratory of Ophthalmology, Retina DivisionZhongshan Ophthalmic Center, Sun Yat‐sen University Guangzhou China
| | - Junyan Zhang
- Scientific Supporting Department, Bothwin Pte. Ltd. Branch of Clinical Epidemiology and Evidence‐Based Medicine, Shanghai Medical Association Shanghai China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Retina DivisionZhongshan Ophthalmic Center, Sun Yat‐sen University Guangzhou China
| | - Lin Lu
- State Key Laboratory of Ophthalmology, Retina DivisionZhongshan Ophthalmic Center, Sun Yat‐sen University Guangzhou China
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Teo KYC, Ng WY, Lee SY, Cheung CMG. Management of Myopic Choroidal Neovascularization: Focus on Anti-VEGF Therapy. Drugs 2016; 76:1119-33. [PMID: 27364753 DOI: 10.1007/s40265-016-0605-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Myopic choroidal neovascularization (mCNV) is the second most common form of CNV after age-related macular degeneration (AMD). It is a sight-threatening complication of pathologic myopia (PM) and often affects patients in their working years causing significant impact on quality of life. Previous therapies such as photodynamic therapy with verteporfin have shown limited success. Due to the similarities in pathogenesis of mCNV and AMD CNV, anti-vascular endothelial growth factor therapy (anti-VEGF), which has so far been the mainstay of treatment for AMD CNV, has been shown to be effective in the treatment of mCNV and has become the first-line treatment of choice. This article aims to examine briefly the epidemiology and pathophysiology of mCNV, as well as review the evidence for efficacy, safety, and clinical use of anti-VEGF treatment for mCNV.
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Affiliation(s)
- Kelvin Yi Chong Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Wei Yan Ng
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Shu Yen Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.
- Duke-NUS Graduate Medical School, Singapore, Singapore.
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Pakzad-Vaezi K, Mehta H, Mammo Z, Tufail A. Vascular endothelial growth factor inhibitor use and treatment approach for choroidal neovascularization secondary to pathologic myopia. Expert Opin Biol Ther 2016; 16:873-81. [PMID: 26985834 DOI: 10.1517/14712598.2016.1167868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Myopic choroidal neovascularization (CNV) is the most common cause of CNV in those under 50 years of age. It is a significant cause of visual loss in those with pathologic myopia. The current standard of care involves therapy with intravitreal inhibitors of vascular endothelial growth factor (VEGF). AREAS COVERED The epidemiology of myopia, high myopia, pathologic myopia, and myopic CNV is reviewed, along with a brief discussion of historical treatments. The pharmacology of the three most commonly used anti-VEGF agents is discussed, with an emphasis on the licensed drugs, ranibizumab and aflibercept. A comprehensive clinical approach to diagnosis and treatment of myopic CNV is presented. EXPERT OPINION The current standard of care for myopic CNV is intravitreal inhibition of VEGF, with ranibizumab and aflibercept licensed for intraocular use. The diagnosis, OCT features of disease activity and retreatment algorithm for myopic CNV is different from wet age-related macular degeneration. In the long-term, myopic CNV may be associated with gradual, irreversible visual loss due to progressive chorioretinal atrophy, for which there is currently no treatment.
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Affiliation(s)
- Kaivon Pakzad-Vaezi
- a Department of Medical Retina, Moorfields Eye Hospital NHS Foundation Trust , London , United Kingdom
| | - Hemal Mehta
- a Department of Medical Retina, Moorfields Eye Hospital NHS Foundation Trust , London , United Kingdom
| | - Zaid Mammo
- b Ophthalmology and Visual Sciences , University of British Columbia , Vancouver , Canada
| | - Adnan Tufail
- a Department of Medical Retina, Moorfields Eye Hospital NHS Foundation Trust , London , United Kingdom
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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 bevacizumab for choroidal neovascularization due to pathologic myopia: long-term outcomes. Graefes Arch Clin Exp Ophthalmol 2015; 254:445-54. [DOI: 10.1007/s00417-015-3076-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/25/2015] [Accepted: 06/02/2015] [Indexed: 01/14/2023] Open
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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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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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Forty-two-month outcome of intravitreal bevacizumab in myopic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol 2014; 253:511-7. [PMID: 25016478 DOI: 10.1007/s00417-014-2721-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate the long-term efficacy of bevacizumab in the treatment of choroidal neovascularization (CNV) secondary to pathological myopia. METHODS In this retrospective single-center non-comparative study the medical records of 29 eyes from 29 patients with naïve CNV secondary to high myopia and at least 42 months of follow up were reviewed. All eyes received a loading dose of one intravitreal injection per month for two consecutive months and were retreated on an as-needed basis during the course of follow up. The main outcome measures were post-treatment ETDRS best-corrected visual acuity (BCVA) and visual stabilization over time. Stepwise linear regression analysis was performed to identify prognostic factors for visual acuity gain and final visual acuity outcome at 42 months. RESULTS At 42 months of follow-up bevacizumab was associated with the maintenance of significant benefits in visual acuity compared to baseline. No adverse ocular or systemic effects from treatment were encountered. No statistically significant correlations were found between BCVA change and any of the quantitative variables. However, when final BCVA was taken as a dependent variable and CNV size and pre-treatment VA were included as predictors, a bivariate model was identified by stepwise regression which gave a 75 % of explained variance. CONCLUSIONS Bevacizumab treatment was found to be efficacious in the treatment of myopic CNV, resulting in stable gains in visual acuity lasting at least 42 months, without any adverse ocular or general events. Myopic CNV size was identified as a significant prognostic factor.
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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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Ho M, Liu DTL, Young AL, Lam DSC. Management of Choroidal Neovascularization Secondary to Pathological Myopia: The Era of Changes. Asia Pac J Ophthalmol (Phila) 2014; 3:94-103. [PMID: 26107492 DOI: 10.1097/apo.0000000000000017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Choroidal neovascularization (CNV) secondary to pathological myopia is an important cause of significant visual impairment in young adults. High myopia is particularly prevalent in Asian population. New scientific contributions have been made to the understanding of high myopia and myopic CNV. Treatment for myopic CNV has previously relied on photodynamic therapy, laser photocoagulation, and submacular surgery. The treatment outcomes from these modalities are, however, controversial. The introduction of antiangiogenic agents including bevacizumab and ranibizumab has brought the treatment of myopic CNV into a new era. The purpose of this review was to provide an overview of the natural history of myopic CNV, the prognostic factors, and the various treatment options including laser photocoagulation and photodynamic therapy, with particular attention on antiangiogenic agents.
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Affiliation(s)
- Mary Ho
- From the *Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China; and †Dennis Lam and Partners Eye Center, Central Building, Central, Hong Kong, People's Republic of China
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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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Tan CS, Chew MC, Lim KH, Lim TH. Factors affecting visual outcome of myopic choroidal neovascularization treated with verteporfin photodynamic therapy. Int J Ophthalmol 2013; 6:327-30. [PMID: 23826527 PMCID: PMC3693014 DOI: 10.3980/j.issn.2222-3959.2013.03.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 04/25/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To evaluate the visual outcomes of choroidal neovascularization (CNV) secondary to pathological myopia and the impact of novel risk factors affecting the final visual outcome. METHODS Interventional case series of 18 consecutive patients with pathological myopia treated with photodynamic therapy (PDT). Inclusion criteria were spherical equivalent -6D or worse or features of pathological myopia on retinal examination. The main outcome measure was final best-corrected visual acuity (BCVA). RESULTS Of 18 eyes, 13 (72.2%) avoided moderate visual loss (≥3 lines of LogMAR BCVA) and 5 eyes (27.8%) improved by at least 1 line after 1 year. Patients with LogMAR BCVA ≤0.3 (Snellen equivalent 20/40) at one year were younger than those with BCVA >0.3 (mean age 39.0 vs 61.6 years, P=0.001). A higher proportion of eyes with greatest linear dimension (GLD) of ≤1000µm avoided moderate visual loss (100% vs 50%, P=0.026). Among patients who were treated within 2 weeks of visual symptoms, 88.9% avoided the loss of 3 or more lines compared to 55.6% for those who presented later. The mean improvement in LogMAR BCVA of those with GLD ≤1000µm was +0.12 compared to a loss of 0.55 LogMAR units for those with GLD >1000µm (P=0.02). Visual outcomes were not associated with gender or refractive error. CONCLUSION Good visual outcome in myopic CNV is associated with younger age, smaller lesion size and earlier initiation of treatment. These factors are relevant for ophthalmologists considering treatment options for myopic CNV.
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Affiliation(s)
- Colin S. Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore
| | - Milton C. Chew
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Kai-Hung Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Tock-Han Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore
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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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Lim EH, Jang YS, Lew YJ, Yoo SJ. Comparison of Two Doses of IVB and Prognostic Factor on Myopic CNV : 1-Year Outcome. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.12.1807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Eun Hae Lim
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University, Seoul, Korea
| | - Yoon Soo Jang
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University, Seoul, Korea
| | - Young Ju Lew
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University, Seoul, Korea
| | - Su Jin Yoo
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University, Seoul, Korea
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