Intravitreous bevacizumab to treat subfoveal choroidal neovascularization in highly myopic eyes: short-term results

Ten-Year Outcomes of Intravitreal Bevacizumab for Myopic Choroidal Neovascularization: Analysis of Prognostic Factors

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.

Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN)

Myopia is a highly frequent ocular disorder worldwide and pathologic myopia is the 4th most common cause of irreversible blindness in developed countries. Pathologic myopia is especially common in East Asian countries. Ocular alterations associated with pathologic myopia, especially those involving the macular area-defined as myopic maculopathy-are the leading causes of vision loss in patients with pathologic myopia. High myopia is defined as the presence of a highly negative refractive error (>-6 to -8 diopters) in the context of eye elongation (26-26.5 mm). Although the terms high myopia and pathologic myopia are often used interchangeably, they do not refer to the same eye disease. The two key factors driving the development of pathologic myopia are: 1) elongation of the axial length and 2) posterior staphyloma. The presence of posterior staphyloma, which is the most common finding in patients with pathologic myopia, is the key differentiating factor between high and pathologic myopia. The occurrence of staphyloma will, in most cases, eventually lead to other conditions such as atrophic, traction, or neovascular maculopathy. Posterior staphyloma is for instance, responsible for the differences between a myopic macular hole (MH)-with and without retinal detachment-and idiopathic MH. Posterior staphyloma typically induces retinal layer splitting, leading to foveoschisis in myopic MH, an important differentiating factor between myopic and emmetropic MH. Myopic maculopathy is a highly complex disease and current classification systems do not fully account for the numerous changes that occur in the macula of these patients. Therefore, a more comprehensive classification system is needed, for several important reasons. First, to more precisely define the disease stage to improve follow-up by enabling clinicians to more accurately monitor changes over time, which is essential given the progressive nature of this condition. Second, unification of the currently-available classification systems would establish standardized classification criteria that could be used to compare the findings from international multicentric studies. Finally, a more comprehensive classification system could help to improve our understanding of the genetic origins of this disease, which is clearly relevant given the interchangeable-but erroneous-use of the terms high and pathologic myopia in genetic research.

Pharmacotherapy of Myopic Choroidal Neovascularization

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.

Management of Myopic Choroidal Neovascularization: Focus on Anti-VEGF Therapy

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.

Understanding the Determinants of Myopic Choroidal Neovascularization and Response to Treatment

Purpose

The pathophysiologic pathways that govern the development of choroidal neovascularization (CNV) are complex. Patchy atrophy and lacquer cracks are known to be major anatomic risk factors for the development of myopic CNV, but they are not alone and much remains to be understood about other factors that influence development. In addition, a greater understanding of the modifiable and nonmodifiable factors that influence outcome, resolution, and recurrence after intravitreal injection of anti-vascular endothelial growth factor (VEGF) could lead to more personalized treatment algorithms that integrate parameters other than the presence of CNV itself and could help improve clinical outcomes and reduce recurrence.

Methods

We reviewed recently published data on risk factors for CNV and predictors of response to anti-VEGF treatments. In particular, data pertaining to age, sex, genetic predisposition, baseline visual acuity, axial length, staphyloma, lacquer cracks, atrophic lesions, choroidal thickness or choroidal thinning, characteristics of CNV such as duration, localization, and size of CNV, and treatment considerations such as choice of treatment, loading doses, and combination treatments were reviewed.

Results

Our analysis showed that the body of evidence is incomplete.

Conclusions

Additional studies are required to identify high-risk patients and to develop personalized therapeutic approaches.

Fluorescein angiography and spectral-domain optical coherence tomography for monitoring anti-VEGF therapy in myopic choroidal neovascularization

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.

Comparison of 1-year therapeutic effect of ranibizumab and bevacizumab for myopic choroidal neovascularization: a retrospective, multicenter, comparative study

Background

To compare the long-term efficacy of ranibizumab versus bevacizumab for myopic choroidal neovascularization (CNV).

Methods

This was a retrospective, multicenter, comparative, non-randomized study of 64 consecutive patients with myopic CNV treated with ranibizumab (22 patients) or bevacizumab (42 patients). Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography were evaluated before and after treatment. All the patients were followed for at least 12 months.

Results

BCVA (logarithm of the minimal angle of resolution) improved from 0.63 ± 0.30 to 0.43 ± 0.27, 0.41 ± 0.37, 0.40 ± 0.39, 0.39 ± 0.43, and 0.39 ± 0.42 at 1, 2, 3, 6, and 12 months after treatment in the ranibizumab group, and from 0.67 ± 0.28 to 0.52 ± 0.31, 0.49 ± 0.31, 0.47 ± 0.31, 0.42 ± 0.32, and 0.46 ± 0.43 in the bevacizumab group (all P < 0.05 compared with baseline BCVA in each group). CFT decreased by 20.21%, 19.58%, and 22.43% from the baseline 304 ± 76 μm at 3, 6, and 12 months after treatment in the former group, and by 15.20%, 15.67%, and 15.56% from the baseline 297 ± 62 μm in the latter group (all P < 0.05 compared with baseline CFT in each group). BCVA improvement and CFT reduction did not statistically differ when compared at the same periods from treatment between 2 groups. Neither ocular nor systemic safety problems appeared during follow up.

Conclusions

This study showed a similar functional and anatomical improvement after treatment of ranibizumab and bevacizumab for myopic CNV over a 12-month follow-up period.

Management of Choroidal Neovascularization Secondary to Pathological Myopia: The Era of Changes

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.

Intravitreal anti-vascular endothelial growth factor for choroidal neovascularization secondary to pathologic myopia: systematic review and meta-analysis

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.

Summary of prognostic factors for choroidal neovascularization due to pathological myopia treated by intravitreal bevacizumab injection

AIM

This systematic review assesses the prognostic factors for intravitreal bevacizumab injection (IVB) in the treatment of choroidal neovascularization (CNV) due to pathological myopia.

METHODS

The literature searches were performed in Ovid Medline, EMBASE and CENTRAL. Relevant studies with prognostic data on best corrected vision acuity (BCVA) after intravitreal bevacizumab injection were included for review. Two reviewers participated in the data retrieval and independently assessed each included study.

RESULTS

A total 252 articles were retrieved, including 16 studies containing the most updated and complete data on prognostic factors for neovascularization due to pathological myopia treated by intravitreal bevacizumab injection. A great number of quantitative, clinical, and treatment-related factors were determined to have a positive influence on vision outcome after intravitreal bevacizumab.

CONCLUSION

A lower rate of development of chorioretinal atrophy, smaller pretreatment CNV size, and younger age were indentified as the most consistently significant prognostic factors affecting the efficacy of IVB in eyes of myopic CNV and were associated with improved BCVA. A worse BCVA after IVB in eyes with myopic CNV probably was associated with subfoveal CNV, lower baseline BCVA, longer duration of CNV, incomplete regression of CNV, subretinal hemorrhage, and previous PDT treatment. No apparent association were observed between the refraction error, axial length, lens status and change in BCVA after IVB. We indentified significant prognostic factors in this systematic review study that might allow for the selection of patients with myopic CNV which are most likely to benefit from IVB.

Choroidal neovascularization in pathological myopia

Myopic choroidal neovascularization (CNV) is one of the leading causes of visual impairment worldwide. The clinical and socioeconomic impact of myopic CNV in Asian countries is particularly significant due to rising trend in the prevalence and severity of pathological myopia. The exact pathogenesis of myopic CNV remains unclear and there is paucity of information with respect to incidence and risk factors for myopic CNV from prospective studies. Furthermore, there are no recognized measures that may prevent or delay the development of CNV in eyes with pathological myopia. Advances have been made in the diagnosis and characterization of myopic CNV over the years. Until recently, treatment modalities for myopic CNV were limited to thermal laser photocoagulation and photodynamic therapy with verteporfin, both these modalities primarily aim at prevention of further visual loss. In the last 5 years, inhibitors of vascular endothelial growth factor (VEGF) have been used successfully and may improve vision to some extent. Nevertheless, the long-term safety and efficacy of anti-VEGF agents remains unknown. Furthermore, the risk of developing chorioretinal atrophy remains the key factor in determining the final visual outcome. This review article summarizes the current literature on myopic CNV, highlighting new evolving diagnostic and treatment modalities, prognostic factors influencing visual outcome, and areas of future research.

Anti-vascular endothelial growth factor for myopic choroidal neovascularization

Myopic choroidal neovascularization (CNV) is a vision-threatening complication in the eyes with pathological myopia, which is particularly prevalent among young and middle-aged Asians globally. To date, the verteporfin in photodynamic therapy study is the only randomized-controlled study in treatment of subfoveal myopic CNV. However, its long-term benefit is controversial. Recently, intravitreal injections of anti-vascular endothelial growth factors have shown promising results. In the absence of randomized-controlled trial comparing the efficacy of anti-vascular endothelial growth factors with photodynamic therapy and placebo, the purpose of this article is to review the current studies on functional and anatomical outcomes in both subfoveal and juxtafoveal myopic CNV. Furthermore, the influences of various doses and frequencies, as well as age and previous photodynamic therapy treatment on its effect are described.

Intravitreal bevacizumab therapy on an as-per-needed basis in subfoveal choroidal neovascularization secondary to pathological myopia: 2-year outcomes of a prospective case series

PURPOSE

To evaluate the effects of intravitreal bevacizumab in the treatment of subfoveal choroidal neovascularization (CNV) related to pathological myopia.

METHODS

Thirty eyes with treatment-naive CNV were included. Best-corrected visual acuity on Early Treatment Diabetic Retinopathy Study chart, optical coherence tomography (OCT), and fluorescein angiography assessment was performed at baseline and thereafter monthly for more than 24 months. Intravitreal bevacizumab on an as-per-needed basis was administered if either persistent intraretinal/subretinal fluid was detected on OCT or the presence of leakage was noted on fluorescein angiography. Primary outcome measures included the change in mean best-corrected visual acuity and the proportion of eyes improving by three lines or greater. Secondary outcome measures included the change in mean central macular thickness on OCT. The proportion of eyes with resolution of intraretinal/subretinal fluid on OCT and leakage on fluorescein angiography over the follow-up was also noted.

RESULTS

Mean best-corrected visual acuity improved from 54.8 ± 14.8 (Early Treatment Diabetic Retinopathy Study letters ± SD) to 59.03 ± 17.0 at 3 months, subsequently stabilizing to 58.63 ± 18.52 at 12 months and 59.25 ± 20 at 24 months. A statistically significant difference was detected only at the 1-month examination. Best-corrected visual acuity at 24 months showed a 3-line improvement in 36.6% of cases and at least a 1-line increment in 43.3% of cases. Mean central macular thickness showed no significant reduction from baseline (216.8 ± 86 µm) up to the end of 24 months (205 ± 77.8 µm). At the last visit, a complete CNV closure was obtained in 93% of cases while intraretinal/subretinal fluid was detected on OCT in 13% of cases. The mean number of intravitreal bevacizumab injections was 4.73 (range, 1-10) at the end of 12 months and 5.9 (range, 1-13) at the end of the 24 months.

CONCLUSION

Intravitreal bevacizumab injection for myopic subfoveal CNV administered on an as-per-needed basis over 24 months of follow-up achieved stabilization of vision with >90% CNV closure rate.

Primary intravitreal ranibizumab for myopic choroidial neovascularisation

Myopic chorodial neovascularisation (mCNV) is an important cause of visual loss in high myopia with almost 10% of eyes with pathological myopia developing mCNV. Intravitreal anti-VEGF agents have recently been documented to be effective in mCNV. However, controversy exists regarding the optimal drug, its dose, and the frequency of administration. We performed a retrospective case review examining patients who had myopia of less than -6D and a chorodial neovascular membrane diagnosed on fundus fluorescein angiography (FFA) that were treated with 3 injections of ranibizumab (Lucentis) 5mg/0.05ml given at monthly intervals. The course was repeated if the ocular coherence tomography (OCT) continued to show intra-retinal oedema at review. We recorded logMAR visual acuities and central foveal thickness (CFT) at baseline and final review. Improvement in visual acuity was significantly improved (p = 0.049) by a mean of 0.24 logMAR (range 0 to 0.74). Every patient achieved at least visual stability. Mean CFT reduction was also significantly improved (p = 0.02) by a mean of 109 microns (range -8 to 198). Our series and current literature seem to support as primary treatment a standard dose of an anti-VEGF agent. Further, larger studies are required to clarify whether any particular injection strategy is clearly superior.

Intravitreal injection of 2.5 mg bevacizumab for treatment of myopic choroidal neovascularization in treatment-naive cases: a 2-year follow-up

PURPOSE

The purpose of this study was to evaluate the safety and efficacy of intravitreal bevacizumab in treatment-naive patients with choroidal neovascularization (CNV) secondary to pathologic myopia over a 2-year interval.

METHODS

Patients diagnosed with myopic CNV who had not received previous treatment were given intravitreal injections of bevacizumab (2.5 mg/0.1 mL). All patients were retrospectively evaluated using best-corrected visual acuity (BCVA) and central macular thickness (CMT) measured with optical coherence tomography (OCT).

RESULTS

Twenty-six eyes of 26 patients aged 15-81 years (mean, 42.6 years) were enrolled. OCT images demonstrated that the mean CMT±standard deviation (SD) significantly changed from 270±47 μm at baseline to 228±35, 218±35, 212±25, 210±29, and 209±30 μm in the 1st, 3rd, 6th, 12th, and 24th post-treatment months, respectively (P<0.001 for all). The BCVA in logarithm of the minimum angle of resolution±SD significantly changed from 0.75±0.43 at baseline to 0.57±0.44, 0.42±0.44, 0.39±0.47, 0.41±0.44, and 0.42±0.41 in the 1st, 3rd, 6th, 12th, and 24th post-treatment months, respectively (P<0.001 for all). The mean number of injections was 1.69 (range, 1-4) within the 24-month period. The follow-up period ranged from 24 to 35 months (mean, 28 months). No other ocular or systemic adverse effects were observed.

CONCLUSIONS

Although the present study lacked a control group, the results in this small series of patients over the 2-year follow-up period indicate that intravitreal injection of 2.5 mg bevacizumab is effective and safe in patients with myopic CNV.

Combined therapy: photodynamic therapy and bevacizumab to treat myopic neovascular membranes. One-year follow-up

PURPOSE

The purpose of this study was to evaluate whether combined customized photodynamic therapy (PDT) and bevacizumab in myopic choroidal neovascularization can improve vision and whether it is possible to decrease the frequency and number of intravitreal antiangiogenic injections.

METHODS

A prospective, consecutive, noncomparative, interventional case series of 36 patients with myopic choroidal neovascularization, treated with an initial dose of PDT and intravitreal bevacizumab 48 hours to 60 hours afterward. Retreatments were carried out as required with monthly bevacizumab and PDT every 3 months if there were relapses. Follow-up lasted 1 year in all cases.

RESULTS

The mean best-corrected visual acuity increased from 44 letters before the initial treatment to 59.5 letters at the 12-month follow-up (P < 0.01). Compared with initial vision, 94.5% of the eyes had the same or better vision and 5.5% lost fewer than 6 lines of vision. The mean number of PDT treatments was 1.1 per patient, and the mean number of bevacizumab injections was 1.5 per patient. Only 1 initial treatment with PDT + bevacizumab was necessary in 28 cases (77.8%).

CONCLUSION

Combined personalized PDT + bevacizumab therapy makes it possible to obtain visual results similar to those obtained in monotherapy studies but with fewer intravitreal injections. It appears to be an interesting option for this type of patient.

Intravitreal bevacizumab to treat myopic choroidal neovascularization: 2-year outcome

BACKGROUND

Myopic maculopathy is the leading cause of subfoveal choroidal neovascularization (CNV) among patients under 50 years of age. New antiangiogenic drugs are being used off-label to treat myopic CNV and the short-term outcome of these therapies has been reported. The aim of this study is to report the changes in best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) in highly myopic CNV treated by intravitreal bevacizumab at 2 years.

METHODS

Prospective non-randomized, interventional case series study of 19 highly myopic eyes from 18 patients with subfoveal and juxtafoveal CNV treated by three monthly intravitreal injections of 1.25 mg bevacizumab. Patients were evaluated for BCVA and OCT at baseline and then monthly for 2 years.

RESULTS

Eleven eyes were naive for treatment and eight eyes had been previously treated by photodynamic therapy. LogMAR BCVA averaged 0.54 (SD 0.25, range 0.2-1.0; Snellen 20/69) at baseline; 0.40 (SD 0.35, range 0.0-1.2; Snellen 20/50) at 1 year; and 0.47 (SD 0.31, range 0.0-1.0; Snellen 20/59) at 2 years (p = 0.04 and p = 0.20, respectively, Student's t test paired data). Re-treatment was performed in four eyes during the first year: three eyes at month six and one eye at month 12. Four eyes required one re-injection during the second year at months 14, 18, 20, and 24. Neither ocular nor systemic adverse reactions were detected.

CONCLUSIONS

Intravitreal bevacizumab seems to be effective for subfoveal and juxtafoveal CNV in highly myopic eyes. BCVA gain decreases and is no longer significant by the end of the second year.

Bevacizumab for choroidal neovascularization secondary to pathologic myopia: Is there a decline of the treatment efficacy after 2 years?

BACKGROUND

The Verteporfin in Photodynamic Therapy (VIP) Study failed to prove a statistically significant benefit for myopic choroidal neovascularization (CNV) at the end of the second year. Therefore, we wanted to evaluate whether the early effects seen under anti-VEGF treatment can be maintained over longer follow-up intervals.

METHODS

This consecutive case series included all patients at the Centre for Ophthalmology, Tuebingen, with a 2-year follow-up after treatment with 1.25 mg of bevacizumab alone or in combination with photodynamic therapy. Twenty-one eyes from 19 patients were analyzed in the retrospective evaluation of best-corrected visual acuity (BCVA) and central foveal thickness (CFT).

RESULTS

Mean logMAR BCVA improved from 0.64 at baseline to 0.55 after 1 year (p = 0.32) and remained 0.55 at 2 years (p = 0.23). A subgroup analysis showed that mean logMAR BCVA in the monotherapy group improved from 0.7 to 0.5 at 2 years (n = 11, p = 0.06). In the combined therapy group, mean logMAR BCVA changed from 0.55 to 0.59 at 2 years (n = 10, p = 0.69). Mean CFT decreased significantly in both groups by 168 microm (p < 0.001) and 76 microm (p < 0.05) in the monotherapy and in the combined groups, respectively. No complications or adverse effects were observed.

CONCLUSION

Although the limitations of the study design have to be acknowledged and carefully discussed, we found no obvious superiority of a combined treatment for myopic CNV, at least in terms of the functional outcome and the injection frequency. The results indicate that bevacizumab might be beneficial in the treatment of patients with CNV secondary to pathologic myopia.

Low-fluence-rate photodynamic therapy to treat subfoveal choroidal neovascularization in pathological myopia. A study of efficacy and safety

BACKGROUND

To evaluate the efficacy and safety of low-fluence-rate photodynamic therapy (LFPDT) to treat choroidal neovascularisation (CNV) secondary to pathological myopia (PM).

METHODS

Twenty-five eyes with CNV in PM underwent LFPDT, with a standard dose of verteporfin and timing but adopting fluence and irradiance rates reduced to 25 mJ/cm2 and 300 mW/cm2, respectively. Best corrected visual acuity (BCVA) was measured and biomicroscopy and fluorescein angiography (FA) were evaluated. Particular attention was paid to choroidal hypoperfusion, and to changes (depigmentation/atrophy) at the RPE level in areas exposed to laser light.

RESULTS

After a mean follow-up of 13.4+/-2.46 months (range: 12-21), and 1.37+/-0.66 treatments (range: 1-3), BCVA was stable in 29 (91%) eyes. Two (6%) patients gained more than three lines and one (3%) eye lost more than three lines. Mean greatest linear dimension did not change significantly (p=0.08) at the end of follow-up. RPE depigmentation was present in six eyes (18%) and no patient showed RPE atrophy.

CONCLUSIONS

LFPDT is effective and safe for CNV secondary to PM treatment, stabilizing visual acuity and lesion size and determining only mild RPE changes. Further controlled studies are needed to demonstrate the long-term efficacy and safety of this treatment option.

Central retinal sensitivity after intravitreal injection of bevacizumab for myopic choroidal neovascularization

PURPOSE

To evaluate retinal sensitivity in the macular area after intravitreal injection of bevacizumab in eyes with myopic choroidal neovascularization (mCNV).

DESIGN

Prospective interventional case series.

METHODS

Twenty-two eyes of 21 patients with mCNV were treated with intravitreal injections of bevacizumab. Microperimetry in the macular area was performed with a Micro Perimeter-1 (Nidek, Vigonza, Italy) before, and at 1 month and 6 months after treatment.

RESULTS

After treatment, visual acuity (VA) and central retinal sensitivity were improved significantly. Mean VA in logarithm of the minimal angle of resolution (logMAR) fashion improved from 0.67 +/- 0.34 to 0.43 +/- 0.33 at 1 month, and to 0.34 +/- 0.26 at 6 months [P < .01, respectively]. Mean retinal sensitivity within the central 10 degree field improved from 4.8 +/- 2.8 decibels (dB) to 6.5 +/- 3.2 dB at 1 month and to 7.4 +/- 4.4 dB at 6 months [P < .01, respectively]. These improvements were more prominent in eyes with juxtafoveal mCNV than in eyes with subfoveal mCNV. With treatment, the mean number of measurement points within the scotomas decreased significantly; the absolute scotoma was reduced substantially in 15 (68%) eyes at 6 months. Unfortunately, the absolute scotoma was significantly enlarged in 1 eye (5%) at 1 month and in 4 eyes (18%) at 6 months. Also at 6 months, chorioretinal atrophy had developed in the macular area in 4 eyes (18%).

CONCLUSIONS

Although intravitreal injection of bevacizumab improved retinal sensitivity in the macular area, some eyes showed enlargement of the scotoma after this treatment.