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Gong B, Bo Y, Zhang P, Wang J, Gao L. Efficacy and safety of different conbercept injection regimens in the treatment of choroidal neovascularization in pathological myopia: a retrospective study. Int Ophthalmol 2023; 43:4079-4086. [PMID: 37523104 DOI: 10.1007/s10792-023-02825-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 07/09/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE To investigate the clinical efficacy of conbercept 1 + pro re nata (PRN) (i.e., reinjection as needed after one injection) and 3 + PRN (reinjection as needed after 3 months of injection) regimens in choroidal neovascularization secondary to pathological myopia (PM-CNV). METHODS From 06/2019 to 06/2020, 65 patients (65 eyes) confirmed with PM-CNV were included in this retrospective study. Intravitreal injection of 0.5 mg conbercept was conducted either with the 1 + PRN or 3 + PRN strategy. Patients were followed up for 12 months. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), CNV lesion leakage area, the number of injections, and postoperative adverse reactions were observed. RESULTS The mean age of the patients was 42.10 ± 4.69 years, and the average diopter was - 11.26 ± 2.97D. The BCVA at month 3 in the 3 + PRN (n = 30) group was lower than in the 1 + PRN (n = 35) group (P < 0.001). The CRT at month 3 in the 3 + PRN group was lower than in the 1 + PRN group (P < 0.001). After 12 months, there were no differences in the BCVA and CRT between the two groups (P > 0.05). The number of injections was less in 1 + PRN than in 3 + PRN (2.14 ± 1.06 vs. 3.37 ± 0.76, P < 0.001) at 12 months. No serious treatment-related ocular complications or serious systemic adverse events were found. CONCLUSION The 1 + PRN and 3 + PRN strategies of intravitreal injection of conbercept are effective in treating PM-CNV. The 1 + PRN regimen required fewer injections, and it might be more suitable for the treatment of PM-CNV.
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Affiliation(s)
- Bin Gong
- Department of Ophthalmology, Jinan 2Nd People's Hospital, Jinan, 250001, China
| | - Yuxia Bo
- Department of Ophthalmology, Wucheng Hospital of Traditional Chinese Medicine, Dezhou, 253300, China
| | - Peng Zhang
- Department of Ophthalmology, Jinan 2Nd People's Hospital, Jinan, 250001, China
| | - Jing Wang
- Department of Ophthalmology, Shandong Second Provincial General Hospital, Jinan, 250299, China.
| | - Lei Gao
- Department of Ophthalmology, Jinan 2Nd People's Hospital, Jinan, 250001, China.
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Chen Y, Han X, Gordon I, Safi S, Lingham G, Evans J, Li J, He M, Keel S. A systematic review of clinical practice guidelines for myopic macular degeneration. J Glob Health 2022; 12:04026. [PMID: 35356661 PMCID: PMC8939288 DOI: 10.7189/jogh.12.04026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Myopic macular degeneration (MMD) is a primary cause of blindness and visual impairment in many parts of the world. A review of clinical practice guidelines (CPGs) for intervention selection are required with the increasing demand for MMD management in clinical practice as well as in national health services. Therefore, we aim to systematically review CPGs for MMD and assist the recommendations development of the Package of Eye Care Interventions (PECI) program of the World Health Organization. Methods A systematic review of CPGs published on MMD between 2010 and April 2020 was conducted. Guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Cochrane systematic reviews were also included when the evidence from included CPGs were inadequate or contradict. Results After applying exclusion criteria and conducting the quality appraisal, two CPGs were finally included. The average of the AGREE II ratings for the identified Guidelines were 56 and 63 respectively (7 for each item). To provide further information on interventions for MMD, one Cochrane review on MMD was additionally identified and included in the study. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs were recommended for patients with myopic choroidal neovascularization (mCNV) as first-line therapy to improve vision and reduce central macular thickness, and ranibizumab showed significant effectiveness compared to photodynamic therapy (PDT). PDT was recommended to be performed in those resistant to the treatment by one CPG but lacked of adequate description and support. Data extracted from the Cochrane systematic reviews indicated that anti-VEGF therapy for mCNV had significant effectiveness in improving visual acuity and reducing CMT compared to PDT with moderate to low certainty of evidence. Ranibizumab and bevacizumab were considered as equally effective with moderate certainty. Conclusions The outcomes of this review suggest that high quality clinical practice guidelines for MMD management are limited. Intravitreal injection of anti-VEGF agents was recommended as an effective intervention to treat myopic CNV as the first-line treatment, while there was inadequate guidance for the application of PDT in myopic CNV management. The use of other interventions for MMD were not recommended at this time and additional evidence is called for.
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Affiliation(s)
- Yanxian Chen
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xiaotong Han
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Iris Gordon
- Cochrane Eyes and Vision, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sare Safi
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gareth Lingham
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Jennifer Evans
- Cochrane Eyes and Vision, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jinying Li
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, China
| | - Mingguang He
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Centre for Eye Research Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Stuart Keel
- Vision and Blindness Prevention Programme, World Health Organization, Geneva, Switzerland
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Chen SL, Tang PL, Wu TT. Result of intravitreal aflibercept injection for myopic choroidal neovascularization. BMC Ophthalmol 2021; 21:342. [PMID: 34551746 PMCID: PMC8459492 DOI: 10.1186/s12886-021-02088-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 08/27/2021] [Indexed: 11/24/2022] Open
Abstract
Background The current study aimed to evaluate the efficacy of intravitreal aflibercept injections as the primary treatment for subfoveal/juxtafoveal myopic choroidal neovascularization (CNV) by using optical coherence tomography (OCT). Optical coherence tomography angiography (OCTA) was further used for some patients to detect the changes of CNV after treatment. Methods In the present study, 21 treatment-naive eyes of 21 patients with subfoveal/juxtafoveal myopic CNV received primary intravitreal aflibercept injections and were under follow-up for a minimum duration of 12 months. Among the 21 patients, 12 underwent OCTA to evaluate the changes in central foveal thickness, selected CNV area, and flow area. Results The mean best-corrected visual acuity (BCVA) pertaining to all the patients significantly improved from the baseline value of 0.7 to 0.3 logMAR after treatment for 12 months (P = 0.001). However, the improvements in the median BCVA after treatment for three and 12 months were not statistically significant in the younger group (< 50 years), compared to the older group (≥ 50 years). One aflibercept injection resolved the CNV in 47.6% (10/21) of the patients. The younger group displayed greater improvement in the median central foveal thickness, compared to the older group. OCTA revealed interlacing or disorganized pattern at the level of the outer retinal layer in 12 subjects with myopic CNV. After 3 months of treatment, both groups displayed a decrease in the size of the selected CNV area and flow area. The interlacing group displayed a trend towards better anatomical improvements. Conclusion Intravitreal aflibercept injection provides long-term improvement in visual acuity in patients with myopic CNV. Eyes with the interlacing pattern on OCTA displayed a greater decrease in size and flow after aflibercept injection. Trial registration Before data collection, written informed consent was obtained from each participant, whose identity information was protected by encryption and conversion to a non-identifiable format and removing data links. This study was approved by the Institutional Review Board of Kaohsiung Veterans General Hospital (KSVGH21-CT1–17).
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Affiliation(s)
- Shih-Lin Chen
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., 813, Kaohsiung, Taiwan
| | - Pei-Ling Tang
- Section of Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tsung-Tien Wu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., 813, Kaohsiung, Taiwan. .,School of Medicine, National Yang Ming University, Taipei, Taiwan.
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Ng DSC, Ho M, Iu LPL, Lai TYY. Safety review of anti-VEGF therapy in patients with myopic choroidal neovascularization. Expert Opin Drug Saf 2021; 21:43-54. [PMID: 34228553 DOI: 10.1080/14740338.2021.1952979] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Anti-angiogenesis therapy with intravitreal anti-VEGF agents is now the standard-of-care treatment for myopic choroidal neovascularization (CNV). AREAS COVERED We provide a critical review of the safety of all the anti-VEGF agents currently used for treating myopic CNV including ranibizumab, aflibercept, conbercept, bevacizumab, and ziv-aflibercept. EXPERT OPINION Anti-VEGF therapy for myopic CNV with the currently available anti-VEGF drugs generally have favorable safety outcomes in the short-term. Nonetheless, ocular adverse events following anti-VEGF therapy for myopic CNV may develop and these include worsening or new development of myopic traction maculopathy, increased risk of retinal detachment, and progression of chorioretinal atrophy. Clinicians should be aware of these potential complications and evaluate them before and after anti-VEGF therapy.
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Affiliation(s)
- Danny S C Ng
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Mary Ho
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, New Territories, Hong Kong
| | - Lawrence P L Iu
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, New Territories, Hong Kong
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,2010 Retina and Macula Centre, Kowloon, Hong Kong
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Pilot study of ziv-aflibercept in myopic choroidal neovascularisation patients. BMC Ophthalmol 2020; 20:414. [PMID: 33076864 PMCID: PMC7574189 DOI: 10.1186/s12886-020-01679-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 10/05/2020] [Indexed: 01/26/2023] Open
Abstract
Background Myopic choroidal neovascularization (CNV) is the most common sight-threatening complication associated with high myopia. The present study evaluated the efficacy and safety of the intravitreal injection of ziv-aflibercept in patients with myopic CNV. Methods This prospective interventional study was conducted on 20 eyes of 20 patients with active myopic CNV. Twelve patients were 40 years or older. This study was performed in the Ophthalmology Department of Tanta University Eye Hospital, Tanta University, Egypt. Optical coherence tomography (OCT) was performed for all patients at baseline and monthly after injection during the 6-month follow up period. The main outcome measures were changes in BCVA and CMT. The exploratory outcome measures were CNV size, IOP and the number of injections needed in each age group during the study period. Results Patients with myopic CNV younger than 40 years needed fewer injections (2.00 ± 0.76) than patients older than 40 years (2.50 ± 1.00), with no statistical significance detected between the two groups (p-value 0.246). CNV was smaller in the younger age group (p-value 0.209), best corrected visual acuity (BCVA) improved significantly in the younger and older age groups (p-values 0.001 and 0.028, respectively), and central macular thickness (CMT) decreased significantly after 6 months, from 242.88 ± 23.83 μm to 191.13 ± 13.83 μm in the younger age group and from 251.33 ± 26.60 μm to 197.08 ± 17.64 μm in the older age group (p = 0.001). No significant correlation was found between the final BCVA and either the spherical equivalent or central macular thickness after 6 months, with p-values of 0.135 and 0.145, respectively. No significant changes in IOP were detected in either group after the intravitreal injection. Conclusion Ziv-aflibercept is a highly effective and safe drug in cases of active myopic CNV; however, a larger number of patients and a longer follow-up period are needed to confirm our results. This study was retrospectively registered at clinicaltrials.gov (ID: NCT04290195) on 26-2-2020.
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Ng DSC, Fung NSK, Yip FLT, Lai TYY. Ranibizumab for myopic choroidal neovascularization. Expert Opin Biol Ther 2020; 20:1385-1393. [DOI: 10.1080/14712598.2021.1830969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Nicholas S. K. Fung
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Po Fu Lam, Hong Kong
| | | | - Timothy Y. Y. Lai
- The Chinese University of Hong Kong, Kowloon, Hong Kong
- 2010 Retina and Macula Centre, Tsim Sha Tsui, Hong Kong
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Korol A, Kustryn T, Zadorozhnyy O, Pasyechnikova N, Kozak I. Comparison of Efficacy of Intravitreal Ranibizumab and Aflibercept in Eyes with Myopic Choroidal Neovascularization: 24-Month Follow-Up. J Ocul Pharmacol Ther 2020; 36:122-125. [DOI: 10.1089/jop.2019.0080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrii Korol
- The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine, Odesa, Ukraine
| | - Taras Kustryn
- The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine, Odesa, Ukraine
| | - Oleg Zadorozhnyy
- The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine, Odesa, Ukraine
| | - Natalya Pasyechnikova
- The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine, Odesa, Ukraine
| | - Igor Kozak
- Moorfields Eye Hospital Center, Al Marina, Abu Dhabi, United Arab Emirates
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Hamilton RD, Clemens A, Minnella AM, Lai TYY, Dai H, Sakamoto T, Gemmy Cheung CM, Ngah NF, Dunger-Baldauf C, Holz FG. Real-world effectiveness and safety of ranibizumab for the treatment of myopic choroidal neovascularization: Results from the LUMINOUS study. PLoS One 2020; 15:e0227557. [PMID: 31961888 PMCID: PMC6974143 DOI: 10.1371/journal.pone.0227557] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/20/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose To assess the 1-year effectiveness, safety, and treatment patterns of ranibizumab in patients with myopic choroidal neovascularization (mCNV) enrolled in the LUMINOUS study. Methods This 5-year, prospective, multicenter, observational, study enrolled 30,138 patients across all approved ranibizumab indications from outpatient ophthalmology clinics. 297 consenting patients (≥18 years) with mCNV who were treatment-naïve or prior-treated with ranibizumab or other ocular treatments were enrolled, and treated with ranibizumab according to the local product label. The main outcomes are visual acuity (VA; Early Treatment Diabetic Retinopathy Study letters or equivalent), adverse events during the study, and treatment exposure over 1 year. Results are presented by prior treatment status of the study eye and injection frequency. Results Of the 297 mCNV patients recruited in the study, 108 were treatment-naïve and 175 were prior ranibizumab-treated. At baseline, the mean age of patients was 57.6 years, and 59.0 years and 80.6% and 65.7% were female in the treatment-naïve and prior ranibizumab-treated groups, respectively. Most were Caucasian (treatment-naïve, 88.9%; prior ranibizumab-treated, 86.9%). The mean (±standard deviation [SD]) VA letter changes to 1 year were +9.7 (±17.99) from 49.5 (±20.51) and +1.5 (±13.15) from 58.5 (±19.79) and these were achieved with a mean (SD) of 3.0 (±1.58) and 2.6 (±2.33) injections in the treatment-naïve and prior ranibizumab-treated groups, respectively. Presented by injection frequencies 1–2, 3–4 and ≥5 injections in Year 1, the mean (SD) VA changes were +15.0 (±14.70), +7.7 (±19.91) and −0.7 (±16.05) in treatment-naïve patients and +1.5 (±14.57), +3.1 (±11.53) and −3.6 (±11.97) in prior ranibizumab-treated patients, respectively. The safety profile was comparable with previous ranibizumab studies. Conclusions Ranibizumab treatment for mCNV showed robust VA gains in treatment-naïve patients and VA maintenance in prior ranibizumab-treated patients in a clinical practice setting, consisting mainly of Caucasians. No new safety signals were observed during the study.
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Affiliation(s)
- Robin D. Hamilton
- Department of Medical Retina, Moorfields Eye Hospital NHS Foundation Trust and National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at Moorfields Eye Hospital, London, United Kingdom
| | - Andreas Clemens
- Medical Affairs Region Europe, Ophthalmology, Novartis Pharma AG, Basel, Switzerland
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- * E-mail:
| | - Angelo Maria Minnella
- Department of Ophthalmology, Catholic University of Sacred Hearth—Foundation “Policlinico Universitario A. Gemelli"—IRCCS, Rome, Italy
| | - Timothy Y. Y. Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Hong Dai
- Department of Ophthalmology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | | | | | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
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Long-term outcomes of the intravitreal injection of ranibizumab for the treatment of choroidal neovascularization secondary to pathologic myopia. Int Ophthalmol 2019; 40:833-839. [PMID: 31788714 DOI: 10.1007/s10792-019-01247-w] [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: 09/08/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To analyze the long-term outcomes and safety of intravitreal ranibizumab injections in myopic choroidal neovascularization (CNV). METHODS A retrospective non-randomized analysis of consecutive cases included 17 eyes from 17 patients with subfoveal myopic CNV, treated with intravitreal ranibizumab with at least 30-month follow-up. The patients received three injections monthly, followed by pro re nata regimen. Best-corrected visual acuity (BCVA) measurement, optical coherence tomography and fluorescein angiography were carried out at the baseline and at monthly intervals thereafter. RESULTS Mean follow-up period was 51 months (range 30-98 months). In 12 patients (70.6%), BCVA improved by at least 1 Snellen line, with at least 3-line improvement observed in the case of 8 eyes (47%). Mean central foveal thickness (CFT) decreased from 384.65 ± 103.3 µm at the baseline to 264 ± 86.2 µm at the last follow-up examination (p < 0.001). The final OCT examination revealed 59% (10/17) eyes with CNV-related macular atrophy. Mean number of injections over the follow-up period was 4.82 ± 2.04 per person. Nine patients (53%) required re-injection of the anti-VEGF agent; the mean number of re-injections in this group was 3.44 ± 1.34 per person (range 2-6). No significant adverse events were recorded during the study period. CONCLUSIONS Intravitreal ranibizumab is an effective and safe treatment for CNV secondary to pathologic myopia, contributing to long-term vision improvement and CFT reduction.
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Invernizzi A, Pichi F, Symes R, Zagora S, Agarwal AK, Nguyen P, Erba S, Xhepa A, De Simone L, Cimino L, Gillies MC, McCluskey PJ. Twenty-four-month outcomes of inflammatory choroidal neovascularisation treated with intravitreal anti-vascular endothelial growth factors: a comparison between two treatment regimens. Br J Ophthalmol 2019; 104:1052-1056. [DOI: 10.1136/bjophthalmol-2019-315257] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/17/2019] [Accepted: 11/05/2019] [Indexed: 02/06/2023]
Abstract
Background and aimThere is still no established treatment regimen for eyes with inflammatory choroidal neovascularisation (iCNV) treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. This study compared the 24-month outcomes of two treatment regimens of anti-VEGF injections in eyes with iCNV.MethodsEyes with iCNV treated with anti-VEGF injections were divided into two groups: eyes treated with a loading phase of 3 monthly injections and then re-treated as needed (LOADING group) and eyes treated as needed from the beginning (PRN group). Visual acuity (VA), number of injections and iCNV recurrences at 24 months were compared between the groups.ResultsEighty-two eyes were included, 42 in the LOADING and 40 in the PRN group. Baseline VA (mean(SD)) was 57.3 (15.8) letters in the LOADING vs 60.7 (15.6) letters in the PRN group (p=0.32). The VA (mean (95% CI)) increased at 3 months (+14.8 (10.6 to 18.9) and +11.2 (6.4 to 16) letters in the LOADING and PRN group, respectively) and remained significantly higher than baseline over the entire follow-up in both groups (all p<0.001). At 24 months, there was no difference in VA between the LOADING and PRN group (72.3 (14.0) vs 74.7 (11.3) letters, p=0.36) but the LOADING group received significantly more injections (median (Q1–Q3)) than the PRN (4.5 (3–7) vs 2.5 (2–3.2), p<0.0001). The iCNV recurrences were similar in both groups.ConclusionsiCNV responded well to anti-VEGF with significant and sustained VA improvement. The loading phase did not confer any advantage in terms of outcomes. PRN regimen from the beginning was as effective as more intensive treatment.
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Comparison of Intravitreal Aflibercept and Ranibizumab for Treatment of Myopic Choroidal Neovascularization: One-Year Results-A Retrospective, Comparative Study. J Ophthalmol 2019; 2019:8639243. [PMID: 32082619 PMCID: PMC7012232 DOI: 10.1155/2019/8639243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/29/2019] [Accepted: 10/14/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To compare one-year treatment outcomes of intravitreal aflibercept (IVA) and intravitreal ranibizumab (IVR) for treatment of myopic choroidal neovascularization (mCNV). Methods The medical records of a total of 30 eyes diagnosed with mCNV and underwent IVA or IVR treatment for a minimum one-year follow-up were studied retrospectively. All the subjects had an axial length >26 mm and received a 1 + PRN (pro re nata) regimen IVA or IVR. Best-corrected visual acuity (BCVA) and central macular thicknesses (CMT) on optical coherence tomography were evaluated before and after treatment. Results There were 12 eyes in IVA group, with a mean age of 60.0 ± 10.2 years. The mean BCVA significantly improved from baseline 1.54 ± 0.76 to 0.85 ± 0.61 and the mean CMT significantly decreased from baseline 384.3 ± 119.1 μm to 305.9 ± 75.4 μm to 305.9 ± 75.4 p : 0.024 and p : 0.024 and μm to 305.9 ± 75.4 μm to 305.9 ± 75.4 p : 0.024 and p : 0.024 and p : 0.024 and p : 0.024 and. Conclusions Both IVA and IVR treatment modalities resulted in similar anatomical outcomes but IVA had better visual outcomes in treatment of mCNV.
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Guichard MM, Peters G, Tuerksever C, Pruente C, Hatz K. Outcome Predictors of SD-OCT-Driven Intravitreal Ranibizumab in Choroidal Neovascularization due to Myopia. Ophthalmologica 2019; 243:154-162. [PMID: 31387095 DOI: 10.1159/000501040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 05/20/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE To analyze the efficacy and outcome predictors of SD-OCT (spectral-domain optical coherence tomography)-driven ranibizumab treatment in patients with choroidal neovascularization due to myopia (mCNV). METHODS This prospective investigator-initiated study includes 20 patients with treatment-naïve mCNV. Evaluation included best-corrected visual acuity (BCVA), morphological SD-OCT parameters, and treatment frequency. RESULTS From baseline to month 12, BCVA improved from 58.5 ± 16.9 to 66.1 ± 14.9 letters. Central retinal thickness (CRT) significantly decreased, and qualitative SD-OCT parameters improved. Better baseline visual acuity (VA), lower spherical equivalent, better inner/outer segment line and external limiting membrane integrity showed a significant positive effect on BCVA outcome. Less fluctuation in CRT (worst minus best CRT) indicated better BCVA at 12 months. No serious adverse events occurred. CONCLUSIONS SD-OCT-guided intravitreal ranibizumab treatment in mCNV was efficient and safe. We determined useful predictive factors in regard to VA outcome after 12 months.
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Affiliation(s)
| | | | | | - Christian Pruente
- Department of Ophthalmology, University of Basel, Basel, Switzerland.,Department of Ophthalmology, Kantonsspital Liestal, Liestal, Switzerland
| | - Katja Hatz
- Vista Klinik, Binningen, Switzerland, .,Department of Ophthalmology, University of Basel, Basel, Switzerland,
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OLIMPIC: a 12-month study on the criteria driving retreatment with ranibizumab in patients with visual impairment due to myopic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol 2019; 257:759-768. [DOI: 10.1007/s00417-019-04248-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 12/19/2018] [Accepted: 01/11/2019] [Indexed: 11/26/2022] Open
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Thorell MR, Goldhardt R. Myopic Choroidal Neovascularization: Diagnosis and Treatment Update. CURRENT OPHTHALMOLOGY REPORTS 2019. [DOI: 10.1007/s40135-019-00200-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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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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EFFICACY AND SAFETY OF RANIBIZUMAB FOR THE TREATMENT OF CHOROIDAL NEOVASCULARIZATION DUE TO UNCOMMON CAUSE: Twelve-Month Results of the MINERVA Study. Retina 2018; 38:1464-1477. [PMID: 28704254 PMCID: PMC6086222 DOI: 10.1097/iae.0000000000001744] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Supplemental Digital Content is Available in the Text. Ranibizumab was effective in treating choroidal neovascularization of various etiologies, with a treatment effect of +9.9 letters versus sham at Month 2 and a mean gain of 11.0 letters from baseline to Month 12. The beneficial effects of ranibizumab were observed across all etiology subgroups. Purpose: To evaluate the efficacy and safety of ranibizumab 0.5 mg in adult patients with choroidal neovascularization because of an uncommon cause enrolled in the 12-month MINERVA study. Methods: In this Phase III, double-masked study, adult (≥18 years) patients (N = 178) were randomized 2:1 to receive either ranibizumab (n = 119) or sham (n = 59) at baseline and, if needed, at Month 1 and open-label individualized ranibizumab from Month 2. Best-corrected visual acuity change from baseline to Month 2 (primary endpoint) and Month 12, treatment exposure, and safety over 12 months were reported. Subgroup analysis was conducted on five predefined choroidal neovascularization etiologies (angioid streak, postinflammatory, central serous chorioretinopathy, idiopathic, and miscellaneous). Results: Ranibizumab showed superior efficacy versus sham from baseline to Month 2 (adjusted least-squares mean best-corrected visual acuity: +9.5 vs. −0.4 letters; P < 0.001). At Month 12, the mean best-corrected visual acuity change was +11.0 letters (ranibizumab) and +9.3 letters (sham). Across the 5 subgroups, the treatment effect ranged from +5.0 to +14.6 letters. The mean number of ranibizumab injections was 5.8 (ranibizumab arm) with no new ocular or nonocular adverse events. Conclusion: Ranibizumab 0.5 mg resulted in clinically significant treatment effect versus sham at Month 2. Overall, ranibizumab was effective in treating choroidal neovascularization of various etiologies with no new safety findings.
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HOW VITREOMACULAR INTERFACE MODIFIES THE EFFICACY OF ANTI-VEGF THERAPY FOR MYOPIC CHOROIDAL NEOVASCULARIZATION. Retina 2018; 38:84-90. [DOI: 10.1097/iae.0000000000001500] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Pastore MR, Capuano V, Bruyère E, Miere A, Corbelli E, Querques L, Tognetto D, Bandello F, Querques G, Souied EH. Nine-Year Outcome of Ranibizumab Monotherapy for Choroidal Neovascularization Secondary to Pathologic Myopia. Ophthalmologica 2017; 239:133-142. [PMID: 29268267 DOI: 10.1159/000485112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 11/08/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate the 9-year outcome of ranibizumab monotherapy for myopic choroidal neovascularization (mCNV). METHODS This was a retrospective, nonrandomized, multicentric study to evaluate the long-term outcomes of mCNV treated with ranibizumab monotherapy for at least 9 years according to a strict pro re nata regimen. RESULTS Seventeen eyes of 17 patients (12 women, mean age 57.9 ± 7.7 years) were included. The mean follow-up period was 112.4 ± 3.9 months (range 108-120). The mean difference in best-corrected visual acuity (BCVA) from baseline to the last follow-up was +1.2 ± 15.6 ETDRS letters (p = 0.004, between initial vs. 12 and 24 months). The mean total number of intravitreal injections for each patient was 1.24 ± 1.70 per year (range 2-25). No systemic adverse reactions related to the drug treatment were detected during the 9-year follow-up period. CONCLUSIONS Long-term ranibizumab monotherapy treatment induces unchanged or better BCVA compared to baseline after a 9-year treatment in almost all eyes.
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Affiliation(s)
- Marco R Pastore
- Department of Ophthalmology, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Eye Clinic, Department of Medical Surgical Sciences and Health, University of Trieste, Ospedale Maggiore, Trieste, Italy
| | - Vittorio Capuano
- Department of Ophthalmology, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Elsa Bruyère
- Department of Ophthalmology, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Alexandra Miere
- Department of Ophthalmology, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Eleonora Corbelli
- Department of Ophthalmology, Ospedale San Raffaele, University Vita-Salute, Milano, Italy
| | - Lea Querques
- Department of Ophthalmology, Ospedale San Raffaele, University Vita-Salute, Milano, Italy
| | - Daniele Tognetto
- Eye Clinic, Department of Medical Surgical Sciences and Health, University of Trieste, Ospedale Maggiore, Trieste, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Ospedale San Raffaele, University Vita-Salute, Milano, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Department of Ophthalmology, Ospedale San Raffaele, University Vita-Salute, Milano, Italy
| | - Eric H Souied
- Department of Ophthalmology, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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Cheung CMG, Arnold JJ, Holz FG, Park KH, Lai TY, Larsen M, Mitchell P, Ohno-Matsui K, Chen SJ, Wolf S, Wong TY. Myopic Choroidal Neovascularization. Ophthalmology 2017; 124:1690-1711. [DOI: 10.1016/j.ophtha.2017.04.028] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 04/03/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023] Open
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Lee DH, Kang HG, Lee SC, Kim M. Features of optical coherence tomography predictive of choroidal neovascularisation treatment response in pathological myopia in association with fluorescein angiography. Br J Ophthalmol 2017; 102:238-242. [PMID: 28600301 DOI: 10.1136/bjophthalmol-2017-310244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/03/2017] [Accepted: 05/06/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND/AIMS The aim of this study was to evaluate the usefulness of several optical coherence tomography (OCT) findings to estimate choroidal neovascularisation (CNV) activity in pathological myopia using fluorescein angiography (FA) as a reference. METHODS This was a single-centre, retrospective study. The medical records of patients with active myopic CNV who received intravitreal bevacizumab treatment were reviewed. Parameters to monitor CNV activity were morphological features of CNV on OCT, such as CNV height, central foveal thickness, intraretinal cysts, subretinal fluid, fuzziness of the CNV border, CNV network area on FA, and haemorrhage or exudation on fundus photo. RESULTS There were 46 patients with active CNV enrolled in this study. After intravitreal bevacizumab treatment, all the previously mentioned parameters of CNV were significantly improved. Using logistic regression analyses with backward elimination, the fuzzy border seen on OCT showed the most significant correlation with improvement of leakage on FA, when compared with other variables such as intraretinal cysts, subretinal fluid or central foveal thickness (R2=0.324, p=0.009). CONCLUSION Our study showed that the fuzziness of the hyper-reflective CNV margin showed the most significant improvement and the strongest correlation with the improvement of CNV leakage on FA after intravitreal bevacizumab injections, suggesting its important role as an OCT parameter for the assessment of myopic CNV activity.
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Affiliation(s)
- Dong Hyun Lee
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Goo Kang
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Korol AR, Zadorozhnyy OS, Naumenko VO, Kustryn TB, Pasyechnikova NV. Intravitreal aflibercept for the treatment of choroidal neovascularization associated with pathologic myopia: a pilot study. Clin Ophthalmol 2016; 10:2223-2229. [PMID: 27853350 PMCID: PMC5106219 DOI: 10.2147/opth.s117791] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Purpose To determine the efficacy of intravitreal aflibercept injections for the treatment of patients with choroidal neovascularization (CNV) associated with pathologic myopia. Methods In this uncontrolled, prospective cohort study, 31 eyes of 30 consecutive patients affected by CNV associated with pathologic myopia were treated with intravitreal aflibercept (2 mg) as needed following two initial monthly doses and observed over a 12-month follow-up period. The primary endpoint was change in best-corrected visual acuity (BCVA) at month 12, while central retinal thickness (CRT) on optical coherence tomography (OCT), neovascularization activity on fluorescein angiography, the number of aflibercept injections administered, and safety were examined as secondary endpoints. Results Patients received a mean of 2.6 intravitreal aflibercept injections over the 12-month study period. Compared with baseline, BCVA improved significantly at all time points (P<0.05). Mean (standard deviation [SD]) decimal BCVA was 0.2 (0.1) at baseline and 0.35 (0.16) at month 12. The greatest improvement in BCVA was seen within the first 2 months (P=0.01). Mean (SD) CRT on OCT decreased from 285 (62) µm at baseline to 227 (42) µm (P=0.01) at month 12. There was a continuous decrease in mean CRT on OCT over time. No cases of endophthalmitis, uveitis, stroke, or retinal detachment were noted. No patient demonstrated an intraocular pressure >20 mmHg during any study visit. Conclusion The 12-month results of intravitreal aflibercept for myopic CNV using an as-needed regimen were positive, showing benefits in visual and anatomic outcomes and an acceptable tolerability profile.
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Affiliation(s)
- Andrii R Korol
- The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine, Odessa, Ukraine
| | - Oleg S Zadorozhnyy
- The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine, Odessa, Ukraine
| | - Volodymyr O Naumenko
- The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine, Odessa, Ukraine
| | - Taras B Kustryn
- The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine, Odessa, Ukraine
| | - Nataliya V Pasyechnikova
- The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine, Odessa, Ukraine
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Reduced-fluence verteporfin photodynamic therapy plus ranibizumab for choroidal neovascularization in pathologic myopia. Graefes Arch Clin Exp Ophthalmol 2016; 255:529-539. [DOI: 10.1007/s00417-016-3498-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 08/21/2016] [Accepted: 09/19/2016] [Indexed: 01/27/2023] Open
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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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Bruè C, Pazzaglia A, Mariotti C, Reibaldi M, Giovannini A. Aflibercept as primary treatment for myopic choroidal neovascularisation: a retrospective study. Eye (Lond) 2016; 30:139-45. [PMID: 26514244 PMCID: PMC4709541 DOI: 10.1038/eye.2015.199] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/31/2015] [Indexed: 01/15/2023] Open
Abstract
AIM The aim of this study is to evaluate long-term efficacy of intravitreal injections of aflibercept as primary treatment for subfoveal/juxtafoveal myopic choroidal neovascularisation (CNV).METHODS Thirty-eight treatment-naive eyes of thirty-eight patients with subfoveal/juxtafoveal myopic CNV received initial intravitreal aflibercept injections and were followed for at least 18 months. Aflibercept was applied again for persistent or recurrent CNV, as required. Statistical analysis was carried out using SPSS.RESULTS Mean patient age was 45.8 years, and mean eye refractive error was -7.79 D. For the total patient group (n=38 eyes), mean logMAR best-corrected visual acuity (BCVA) significantly improved from 0.69 at baseline to 0.15 at 18 months (P<0.01). Over half of the treated eyes obtained resolution with one aflibercept injection. Patients were also grouped according to age, as <50 years (n=20 eyes) and ≥50 years (n=18 eyes). Mean BCVA improvement was significantly greater in eyes of the younger myopic CNV group, compared with those of ≥50 years (0.21 vs 0.35; P<0.05). The mean number of aflibercept injections was 1.8 for the <50 years myopic CNV group, and 3.6 for the ≥50 years myopic CNV group (P<0.001). Correlation between spherical equivalent refraction and final visual acuity reached statistical significance only for the <50 years myopic CNV group (P<0.001; Levene's correlation).CONCLUSIONS Intravitreal aflibercept provides long-term visual acuity improvement in myopic CNV. The <50 years old myopic CNV group had significantly fewer injections, with greater visual acuity improvement. Intravitreal aflibercept in myopic CNV does not require the three-injection loading phase used for aflibercept treatment of neovascular age-related macular degeneration.
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Affiliation(s)
- C Bruè
- Ophthalmology, Department of Neuroscience, Polytechnic University of Marche, Ancona, Italy
- Ophthalmology, Macerata Hospital, Macerata, Italy
| | - A Pazzaglia
- Ophthalmology, Sant'Orsola Hospital, Malpighi, Italy
| | - C Mariotti
- Ophthalmology, Department of Neuroscience, Polytechnic University of Marche, Ancona, Italy
| | - M Reibaldi
- Ophthalmology, G. Rodolico Vittorio Emanuele Hospital, Catania, Italy
| | - A Giovannini
- Ophthalmology, Department of Neuroscience, Polytechnic University of Marche, Ancona, Italy
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FACTORS INFLUENCING NEED FOR RETREATMENT AND LONG-TERM VISUAL OUTCOME AFTER INTRAVITREAL BEVACIZUMAB FOR MYOPIC CHOROIDAL NEOVASCULARIZATION. Retina 2015; 35:2457-68. [DOI: 10.1097/iae.0000000000000610] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR CHOROIDAL NEOVASCULARIZATION SECONDARY TO PATHOLOGIC MYOPIA. Retina 2015; 35:2450-6. [PMID: 26049616 DOI: 10.1097/iae.0000000000000632] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Amoaku WM, Gale RP, Lotery AJ, Menon G, Sivaprasad S, Petrillo J, Quinn J. Treatment Satisfaction and Well-Being in Patients with Myopic Choroidal Neovascularization Treated with Ranibizumab in the REPAIR Study. PLoS One 2015; 10:e0128403. [PMID: 26039355 PMCID: PMC4454435 DOI: 10.1371/journal.pone.0128403] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/23/2015] [Indexed: 11/18/2022] Open
Abstract
The Ranibizumab for the Treatment of Choroidal Neovascularisation (CNV) Secondary to Pathological Myopia (PM): an Individualized Regimen (REPAIR) trial was a prospective study exploring the efficacy and safety of intravitreal ranibizumab 0.5 mg using an individualized treatment regimen over 12 months. The current study investigated the impact of treatment with ranibizumab as needed (pro re nata [PRN]) on individuals with myopic choroidal neovascularization (mCNV) in the REPAIR study, using patient-reported outcome measures (PROMs) for treatment satisfaction and well-being. This study included 65 adults with mCNV and a best-corrected visual acuity (BCVA) letter score of 24-78 in the study eye. Patients completed the Macular Disease Treatment Satisfaction Questionnaire (MacTSQ) at months 1, 6 and 12, and the 12-item Well-Being Questionnaire (W-BQ12) at baseline and months 1, 6 and 12. Subgroup analyses investigated the relationship between PROM scores and treatment in the better- or worse-seeing eye (BSE/WSE), number of injections received, baseline BCVA, BCVA improvement and age. Pearson correlations between change in BCVA, MacTSQ scores and W-BQ12 scores were calculated. The main outcome measures were treatment satisfaction measured with the MacTSQ (score 0-72) and well-being measured with the W-BQ12 (score 0-36). Treatment satisfaction significantly increased over the study period (p = 0.0001). Mean MacTSQ scores increased by 9.7 and 10.0 in patients treated in their WSE and BSE, respectively. Treatment satisfaction was highest in individuals receiving only one injection at month 1; however, by month 12, scores were similar across injection subgroups. Patients aged 68 years or older had the highest MacTSQ scores. Well-being scores also significantly increased over the study period (p = 0.03). Mean W-BQ12 scores increased by 1.7 in patients treated in their WSE and by 2.1 in patients treated in their BSE. Individuals aged 40 years or younger had the greatest increases in general well-being. Patients who experienced stable or improved BCVA at month 12 had greater increases in W-BQ12 scores than those who experienced a decrease. Correlations between BCVA, MacTSQ scores and W-BQ12 scores were largely non-significant. In conclusion, treatment satisfaction and well-being increased during treatment with ranibizumab PRN. Although directly comparable data are limited for the MacTSQ and W-BQ12 in mCNV, these results complement PROM outcomes reported in related studies.
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Affiliation(s)
- Winfried M. Amoaku
- University of Nottingham, Academic Ophthalmology, Division of Clinical Neurosciences, and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- * E-mail:
| | - Richard P. Gale
- York Teaching Hospital NHS Foundation Trust, York, United Kingdom
| | - Andrew J. Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Geeta Menon
- Frimley Park Hospital NHS Foundation Trust, Frimley, United Kingdom
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Jennifer Quinn
- Novartis Pharmaceuticals UK Limited, Frimley, United Kingdom
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Stuart A, Ford JA, Duckworth S, Jones C, Pereira A. Anti-VEGF therapies in the treatment of choroidal neovascularisation secondary to non-age-related macular degeneration: a systematic review. BMJ Open 2015; 5:e007746. [PMID: 25941188 PMCID: PMC4420986 DOI: 10.1136/bmjopen-2015-007746] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The aim of this study is to systematically review the evidence for anti-vascular endothelial growth factor (VEGF) therapy in choroidal neovascularisation secondary to conditions other than age-related macular degeneration. DATA SOURCES MEDLINE, MEDLINE in-process, EMBASE and CENTRAL databases and conference abstracts were searched (from inception to Jan 2014). STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS Randomised and non-randomised comparative studies with follow-up of at least 6 months were included and were used to assess clinical effectiveness. STUDY APPRAISAL AND SYNTHESIS METHOD Risk of bias was assessed using the Cochrane risk of bias tool and modified Newcastle-Ottawa Scale. Meta-analysis was not possible due to methodological heterogeneity. RESULTS 16 studies met the inclusion criteria (1091 eyes; 963 pathological myopia, 74 other conditions). There was large variation in risk of bias across studies. An improvement in best-corrected visual acuity in anti-VEGF arms over comparators was reported in all studies. The proportion of patients improving by at least 15 letters in anti-VEGF arms ranged from 27.3% to 70%. There were no significant differences between bevacizumab and ranibizumab. LIMITATIONS Owing to the rarity of choroidal neovascularisation secondary to conditions other than age-related macular degeneration or pathological myopia, there are unlikely to ever be sufficiently powered trials in these populations. CONCLUSIONS Bevacizumab and ranibizumab appear to be effective in improving visual acuity for patients with choroidal neovascularisation secondary to conditions other than age-related macular degeneration. The evidence base is strongest for choroidal neovascularisation secondary to pathological myopia, however, based on current evidence and likely pharmacological pathways, clinicians should consider treatment with either bevacizumab or ranibizumab for rarer causes.
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Affiliation(s)
- Arabella Stuart
- Public Health Directorate, Norfolk County Council, Norwich, UK
| | | | - Susan Duckworth
- Public Health Directorate, Norfolk County Council, Norwich, UK
| | - Colin Jones
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
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El Matri L, Chebil A, Kort F. Current and emerging treatment options for myopic choroidal neovascularization. Clin Ophthalmol 2015; 9:733-44. [PMID: 25987831 PMCID: PMC4422283 DOI: 10.2147/opth.s49437] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Choroidal neovascularization (CNV) is the main cause of visual impairment in highly myopic patients younger than 50 years of age. There are different treatments for myopic CNV (mCNV), with 5- to 10-year outcomes currently. Chorioretinal atrophy is still the most important determinant factor for visual outcome. The purpose of this study is to provide an overview of the current treatments for mCNV, including laser, surgical management, verteporfin photodynamic therapy, and mainly anti-vascular endothelial growth factor therapy. Emerging treatment options are also discussed.
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Affiliation(s)
- Leila El Matri
- Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Faculty of Medicine of Tunis, University of El Manar, Tunis, Tunisia
| | - Ahmed Chebil
- Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Faculty of Medicine of Tunis, University of El Manar, Tunis, Tunisia
| | - Fedra Kort
- Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Faculty of Medicine of Tunis, University of El Manar, Tunis, Tunisia
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Ikuno Y, Ohno-Matsui K, Wong TY, Korobelnik JF, Vitti R, Li T, Stemper B, Asmus F, Zeitz O, Ishibashi T. Intravitreal Aflibercept Injection in Patients with Myopic Choroidal Neovascularization: The MYRROR Study. Ophthalmology 2015; 122:1220-7. [PMID: 25745875 DOI: 10.1016/j.ophtha.2015.01.025] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/21/2015] [Accepted: 01/28/2015] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To evaluate intravitreal aflibercept 2 mg in patients with myopic choroidal neovascularization (CNV). DESIGN An international, phase III, multicenter, randomized, double-masked, sham-controlled study. PARTICIPANTS Patients aged ≥ 18 years with high myopia (≤-6.0 diopters or axial length of ≥ 26.5 mm), active myopic CNV, and best-corrected visual acuity (BCVA) of 73-35 Early Treatment Diabetic Retinopathy Study letters in the study eye were included. METHODS Patients were randomized 3:1 to intravitreal aflibercept or sham. In the intravitreal aflibercept arm, patients received 1 injection at baseline. Additional injections were performed in case of CNV persistence or recurrence at monthly visits through week 44. In the sham arm, patients received sham injections through week 20. At week 24, after assessment of the primary efficacy end point, sham patients received a mandatory intravitreal aflibercept injection followed by intravitreal aflibercept (if disease persisted/recurred) or sham injection every 4 weeks. MAIN OUTCOME MEASURES Mean change in BCVA from baseline to week 24. RESULTS A total of 122 patients were randomized to intravitreal aflibercept (n = 91) or sham (n = 31). Baseline demographics were similar across groups. At week 24, patients in the intravitreal aflibercept and sham groups gained 12.1 and lost 2 letters, respectively (P < 0.0001). By week 48, patients in the intravitreal aflibercept and sham/intravitreal aflibercept groups gained 13.5 and 3.9 letters. Patients in the intravitreal aflibercept group received 2 injections (median) in the first study quarter (week 0-8). Median number of injections in quarters 2 to 4 was 0. Patients in the "sham/intravitreal aflibercept" group received 2 and 1 (median) intravitreal aflibercept injections in quarters 3 and 4. Central retinal thickness improved in parallel with visual gains. Incidence of ocular adverse events was similar in both groups through week 48 (37.4% vs. 38.7); most were assessed by investigators as mild. No deaths occurred. CONCLUSIONS Intravitreal aflibercept 2 mg was effective for treatment of myopic CNV with clinically important visual and anatomic benefits achieved with a limited number of injections given in the first 8 weeks of treatment. No new safety concerns occurred with treatment. Intravitreal aflibercept should be considered as a treatment option for myopic CNV.
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Affiliation(s)
- Yasushi Ikuno
- Department of Ophthalmology, Osaka University School of Medicine, Osaka, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| | - Jean-Francois Korobelnik
- Service d'ophtalmologie, Hopital Pellegrin-CHU de Bordeaux, Bordeaux, France; Université Bordeaux Segalen, Bordeaux, France; INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France
| | - Robert Vitti
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Tummy Li
- Bayer HealthCare Pharmaceuticals, Beijing, China
| | - Brigitte Stemper
- Bayer HealthCare Pharmaceuticals, Berlin, Germany; Department of Neurology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Friedrich Asmus
- Bayer HealthCare Pharmaceuticals, Berlin, Germany; Department of Neurodegeneration, Center of Neurology, University Hospital of Tübingen, and Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Oliver Zeitz
- Bayer HealthCare Pharmaceuticals, Berlin, Germany; Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Wu TT, Kung YH. Two-Year Outcome of Intravitreal Injections of Ranibizumab for Myopic Choroidal Neovascularization. J Ocul Pharmacol Ther 2014; 30:837-41. [PMID: 25162313 DOI: 10.1089/jop.2014.0033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tsung-Tien Wu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Ya-Hsin Kung
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
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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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Iacono P, Battaglia Parodi M, Papayannis A, Kontadakis S, Da Pozzo S, Cascavilla ML, La Spina C, Varano M, Bandello F. Fluorescein angiography and spectral-domain optical coherence tomography for monitoring anti-VEGF therapy in myopic choroidal neovascularization. Ophthalmic Res 2014; 52:25-31. [PMID: 24861045 DOI: 10.1159/000358331] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 01/03/2014] [Indexed: 01/02/2023]
Abstract
AIM To evaluate the agreement between fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT) in detecting myopic choroidal neovascularization (CNV) activity during bevacizumab treatment. METHODS Thirty-four patients with subfoveal myopic CNV were prospectively enrolled. FA and SD-OCT were performed at baseline and at all planned monthly visits. After the first injection, additional treatments were administered following detection of fluid on SD-OCT and/or leakage on FA. κ-Analysis was performed to examine the agreement between FA and SD-OCT. RESULTS At baseline, FA and SD-OCT agreed in 26/34 cases (κ=0.23); sensitivity and specificity were 77.4 and 66.7%, respectively. Seven eyes presented leakage on FA with no fluid on SD-OCT, 1 case showed intraretinal fluid on SD-OCT and no leakage on FA. At the 1-month examination, specificity and κ-value improved, and 30/34 cases showed complete concordance. At the 3- and 4-month examinations, a discordance was noted in 6 cases. From the 5-month examination on, a correspondence was achieved in at least 30/34 cases and reached a perfect match in 11 sessions. CONCLUSIONS Our study confirms the key role of FA in diagnosing myopic CNV. It seems possible there may be a role for SD-OCT in assisting FA to monitor the myopic CNV activity during anti-vascular endothelial growth factor antibody treatment.
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Affiliation(s)
- Pierluigi Iacono
- G.B. Bietti Foundation for Ophthalmology, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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