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Ferreira AM, Vilares-Morgado R, Lima-Fontes M, Falcão M, Falcão-Reis F, Carneiro Â. Chorioretinal Atrophic Lesions Evolution in Patients with Quiescent Myopic Choroidal Neovascularization Followed for More Than 10 Years. Clin Ophthalmol 2024; 18:1381-1390. [PMID: 38770398 PMCID: PMC11104444 DOI: 10.2147/opth.s461515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose To evaluate the progression of chorioretinal atrophic areas associated with myopic choroidal neovascularization (CNV) in high myopic patients followed by a minimum period of 10 years. Patients and Methods Patients with myopic CNV lesions that achieved clinical and structural remissions over 10 years of follow-up were included. Medical records were reviewed for CNV characterization and treatment, best-corrected visual acuity at baseline (BCVA0), immediately after the last treatment (BCVA1) and at the latest visit (BCVA2). Fundus autofluorescence (FAF) was used to quantify the amount of atrophic area increase per year associated with the treated myopic CNV lesion. The first FAF performed after treatment suspension (FAF1) was compared with the most recent exam (FAF2). Results Thirty-six eyes from 36 patients were included. Mean total follow-up was 12.38 ± 2.68 years. Mean number of intravitreal injections (IVI) was 12.50 ± 12.40 and 25% of the eyes had previous treatment with photodynamic therapy (PDT). Mean improvement between BCVA0 and BCVA1 was 5.58 ± 15.98 letters (p < 0.001). However, a drop of 8.03 ± 12.25 letters was noticed between BCVA1 and BCVA2. FAF1 was 6.34 ± 4.92mm2 and increased to 9.88 ± 7.56mm2 (3.54 ± 3.79mm2 variation p < 0.001). The mean growth rate of the atrophic area was 0.89 ± 0.84mm2 per year. BCVA2 negatively correlated with FAF2 (k = -0.498, p = 0.002) being worse in patients with higher atrophic area growth rate (k = -0.341, p = 0.042). Eyes treated with PDT needed less IVI (5.89 ± 5.21 vs 14.70 ± 13.36, p = 0.008) but had larger FAF1 (9.80 ± 5.33 vs 5.19 ± 4.27, p = 0.013) and FAF2 (16.05 ± 7.10 vs 7.83 ± 6.63, p = 0.003). Hypothyroidism was associated with higher atrophy growth rate (1.55 ± 1.15 vs 0.73 ± 0.67, p = 0.016). Conclusion This research demonstrates the importance of chorioretinal atrophy progression after myopic CNV lesions regression and its impact on visual prognosis, reporting a mean yearly growth of 0.89 mm2 in atrophic areas. Previous treatment with PDT and hypothyroidism were identified as risk factors associated with larger atrophic areas and worse visual outcomes.
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Affiliation(s)
| | - Rodrigo Vilares-Morgado
- Department of Ophthalmology, Local Health Unit of São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Mário Lima-Fontes
- Department of Ophthalmology, Local Health Unit of São João, Porto, Portugal
- Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Local Health Unit of São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Local Health Unit of São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Local Health Unit of São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
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Gao L, Song Y, Sun X, Zhang J, Liu Y, Chen Y, Wu Z, Jian Y, Liu X, Lv L, Chen S, Wang YS, Chen N, Ke X, Zhang F. Safety and efficacy of intravitreal injection of conbercept for the treatment of patients with choroidal neovascularization secondary to pathological myopia: Results from the SHINY study. Acta Ophthalmol 2023. [PMID: 38009430 DOI: 10.1111/aos.15810] [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: 08/31/2023] [Accepted: 11/07/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of intravitreal injections of 0.5 mg conbercept in patients with choroidal neovascularization secondary to pathological myopia (pmCNV). METHODS The 177 pmCNV patients were randomly assigned in a 3:1 ratio to receive conbercept or sham injection, respectively. The conbercept group receive conbercept intravitreal injections administered on a pro re nata (PRN) basis after 3 monthly loading doses. The sham group received three consecutive monthly sham injections and then one conbercept injection followed by PRN conbercept intravitreal injections. RESULTS At month 3, the mean BCVA for the two groups were improved by 12.0 letters (conbercept group, from 54.05 letters to 66.05 letters) and 0.6 letters (sham group, from 49.77 letters to 50.33 letters), respectively (p < 0.001). The mean central retinal thickness (CRT) at month 3 in the two groups decreased 62.0 μm (conbercept group, from 348.90 μm to 286.18 μm) and 4.4 μm (sham group, from 347.86 μm to 343.47 μm) (p < 0.001). At month 9, the mean BCVA improved by 13.3 letters in the conbercept group and 11.3 letters in the sham group. The mean CRT decreased 73.6 μm in the conbercept group and 55.9 μm in the sham group (p < 0.001). The most common ocular adverse events were associated with intravitreal injections, such as conjunctival haemorrhage and increased intraocular pressure. CONCLUSION Intravitreal injections of 0.5 mg conbercept provided improvement in visual and anatomical outcomes in pmCNV patients with low rates of ocular and nonocular safety events.
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Affiliation(s)
- Liqin Gao
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Yanping Song
- Department of Ophthalmology, Chinese PLA General Hospital of Central Theater Command, Wuhan, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai, China
| | - Junjun Zhang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, China
| | - Yuling Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China
| | - Zhifeng Wu
- Department of Ophthalmology, Wuxi No.2 People's Hospital, Nanjing Medical University, Wuxi, China
| | - Ye Jian
- Department of Ophthalmology, Daping Hospital and Institute of Surgery Research, Army Medical University, Chongqing, China
| | - Xiaoling Liu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lin Lv
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Shaojun Chen
- Department of Ophthalmology, He Eye Specialist Hospital, Chongqing, China
| | - Yu-Sheng Wang
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Nan Chen
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Xiao Ke
- Medical Research Center, Chengdu Kanghong Biotechnology Inc, Chengdu, China
| | - Feng Zhang
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
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Ng DSC, Chan LKY, Lai TYY. Myopic macular diseases: A review. Clin Exp Ophthalmol 2023; 51:229-242. [PMID: 36594934 DOI: 10.1111/ceo.14200] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/05/2022] [Accepted: 12/16/2022] [Indexed: 01/04/2023]
Abstract
Recent evidence has demonstrated that the global public health burden of myopia is rising rapidly. Highly myopic eyes are associated with increased frequency of eye disorders that can lead to irreversible visual impairment. With recent technological advancement in ophthalmic imaging modalities, various macular complications associated with pathologic myopia are being elucidated. The development and progression of myopic chorioretinal atrophy, myopic macular neovascularization, myopic traction maculopathy and dome-shaped macula are vision-threatening myopic macular diseases. In order to overcome the challenges in managing patients with pathologic myopia, it is important to have a complete understanding in the natural course of these myopic macular diseases. Standardising the classification criteria of pathologic myopia is essential for enhancing clinical surveillance. Personalised pharmaceutical therapy and surgical interventions will help to optimise the treatment outcomes in patients suffering from these myopic macular diseases.
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Affiliation(s)
- Danny S C Ng
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong.,Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Leo K Y Chan
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong.,Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong.,2010 Retina & Macula Centre, Hong Kong, Hong Kong
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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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusions
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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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Ruiz-Medrano J, Montero JA, Flores-Moreno I, Arias L, García-Layana A, Ruiz-Moreno JM. Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN). Prog Retin Eye Res 2019; 69:80-115. [PMID: 30391362 DOI: 10.1016/j.preteyeres.2018.10.005] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 02/09/2023]
Abstract
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.
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Affiliation(s)
- Jorge Ruiz-Medrano
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Javier A Montero
- Department of Ophthalmology, Rio Hortega University Hospital, Valladolid, Spain; Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Retina Unit, Oftalvist, Madrid, Spain
| | | | - Luis Arias
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Alfredo García-Layana
- Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain
| | - José M Ruiz-Moreno
- Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain; Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain; Vissum Corporation, Spain.
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Singh A, Abd AJ, Al-Mashahedah A, Kanwar JR. Corneal Haze, Refractive Surgery, and Implications for Choroidal Neovascularization. DRUG DELIVERY FOR THE RETINA AND POSTERIOR SEGMENT DISEASE 2018:439-477. [DOI: 10.1007/978-3-319-95807-1_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Pece A, Milani P. Intravitreal aflibercept for myopic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol 2016; 254:2327-2332. [DOI: 10.1007/s00417-016-3396-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 05/08/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022] Open
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Munk MR, Rückert R, Zinkernagel M, Ebneter A, Wolf S. The role of anti-VEGF agents in myopic choroidal neovascularization: Current standards and future outlook. Expert Opin Biol Ther 2016; 16:477-87. [PMID: 26666589 DOI: 10.1517/14712598.2016.1132696] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The global prevalence of pathologic myopia is 0.9-3.1%, and visual impairment is found in 0.1-0.5% of European and 0.2-1.4% of Asian studies. Myopic choroidal neovascularization (mCNV) affects 5.2-11.3% of pathologic myopia patients and is a leading cause of vision impairment in the working-age population. Characteristic morphological changes and visual-acuity decrease are diagnostic features. Vascular-Endothelial-Growth-Factor (VEGF) has been identified as a trigger for pathologic neovascularization in these highly myopic patients. AREAS COVERED We cover the epidemiology, pathology and diagnostic aspects of mCNV. The history of therapeutic interventions is described, followed by an overview of current standard-of-care (SOC)-blocking VEGF using bevacizumab (off-label), ranibizumab or aflibercept and improving vision up to 13.5-14.4 letters. Despite good efficacy, an unmet medical need remains. We summarize ongoing and future developments of new drugs to treat or potentially cure mCNV. EXPERT OPINION mCNV is a major global health concern. Early detection and treatment is key for a satisfying outcome. The current SOC, VEGF inhibitors, affords good therapeutic efficacy and reasonable disease stabilization with few intravitreal treatments per year. However, the long-term prognosis is still unsatisfactory, and side-effects like chorioretinal atrophy development are of concern. Therefore, efforts should be intensified to develop more effective therapies.
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Affiliation(s)
- Marion R Munk
- a Ophthalmology , Inselspital, University Hospital Bern , Bern , Switzerland.,b Feinberg School of Medicine , Northwestern University , Chicago , IL , USA
| | - Rene Rückert
- c Eyegnos Ophthalmology Consulting , Bern , Switzerland
| | - Martin Zinkernagel
- a Ophthalmology , Inselspital, University Hospital Bern , Bern , Switzerland
| | - Andreas Ebneter
- a Ophthalmology , Inselspital, University Hospital Bern , Bern , Switzerland
| | - Sebastian Wolf
- a Ophthalmology , Inselspital, University Hospital Bern , Bern , Switzerland
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Zhang Y, Han Q, Ru Y, Bo Q, Wei RH. Anti-VEGF treatment for myopic choroid neovascularization: from molecular characterization to update on clinical application. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:3413-21. [PMID: 26170626 PMCID: PMC4494177 DOI: 10.2147/dddt.s87920] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Choroidal neovascularization (CNV) secondary to pathologic myopia has a very high incidence in global, especially in Asian, populations. It is a common cause of irreversible central vision loss, and severely affects the quality of life in the patients with pathologic myopia. The traditional therapeutic modalities for CNV secondary to pathologic myopia include thermal laser photocoagulation, surgical management, transpupillary thermotherapy, and photodynamic therapy with verteporfin. However, the long-term outcomes of these modalities are disappointing. Recently, intravitreal administration of anti-VEGF biological agents, including bevacizumab, ranibizumab, pegaptanib, aflibercept, and conbercept, has demonstrated promising outcomes for this ocular disease. The anti-VEGF regimens are more effective on improving visual acuity, reducing central fundus thickness and central retina thickness than the traditional modalities. These anti-VEGF agents thus hold the potential to become the first-line medicine for treatment of CNV secondary to pathologic myopia. This review follows the trend of “from bench to bedside”, initially discussing the pathogenesis of myopic CNV, delineating the molecular structures and mechanisms of action of the currently available anti-VEGF drugs, and then systematically comparing the up to date clinical applications as well as the efficacy and safety of the anti-VEGF drugs to the CNV secondary to pathologic myopia.
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Affiliation(s)
- Yan Zhang
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute, College of Optometry and Ophthalmology, Tianjin Medical University, Tianjin, People's Republic of China
| | - Qian Han
- Tangshan Eye Hospital, Tangshan, Hebei Province, People's Republic of China
| | - Yusha Ru
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute, College of Optometry and Ophthalmology, Tianjin Medical University, Tianjin, People's Republic of China
| | - Qiyu Bo
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute, College of Optometry and Ophthalmology, Tianjin Medical University, Tianjin, People's Republic of China
| | - Rui Hua Wei
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute, College of Optometry and Ophthalmology, Tianjin Medical University, Tianjin, People's Republic of China
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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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Clinical characteristics and antivascular endothelial growth factor effect of choroidal neovascularization in younger patients in Taiwan. Taiwan J Ophthalmol 2015; 5:76-84. [PMID: 29018672 PMCID: PMC5602732 DOI: 10.1016/j.tjo.2015.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/05/2015] [Accepted: 03/01/2015] [Indexed: 11/21/2022] Open
Abstract
Background/Purpose: The purpose of this study is to share experiences diagnosing and treating choroidal neovascularization (CNV) in young patients (age ≤ 50 years) at our hospital. Methods: The study reviewed retrospective data of patients (≤ 50 years old) with CNV who received antivascular endothelial growth factor treatment (anti-VEGF) between January 2007 and August 2012 at Shin Kong Wu Ho-Su Memorial Hospital. We recorded the total number of injections, types of drugs, preoperative and final best-corrected visual acuity (BCVA), central retinal thickness (CRT) in optical coherence tomography (OCT), and total follow-up times, and then used two-tailed paired t tests to compare mean changes in BCVA and CRT on OCT. Results: The study enrolled 59 patients ≤ 50 years of age with CNV diagnosed in 67 eyes. The mean age was 36.9 ± 10.0 years (range, 8–50 years). Twenty-one patients were male and 38 patients were female. Forty-two CNV lesions were subfoveal, 19 were juxtafoveal, and five were extrafoveal. The mean total follow-up time was 18.5 ± 19.9 months (range, 0.5–71 months). Pathologic myopia was the most common cause of CNV in this study (47.8%), followed by punctate inner choroidopathy (17.9%), idiopathic CNV (16.4%), polypoidal choroidal vasculopathy (13.4%), angioid streaks (3.0%), and choroidal rupture (1.5%). After anti-VEGF treatment, the mean BCVA improved from 0.69 ± 0.61 to 0.42 ± 0.59 (p < 0.05). CRT decreased from 257.5 ± 48.2 to 210.3 ± 35.7 (p < 0.05). The mean number of injections was 1.9 ± 1.6 (range, 1–9). Conclusion: In this study we found that pathologic myopia, punctate inner choroidopathy, and idiopathic and polypoidal choroidal vasculopathy comprised the four most common causes of CNV in patients ≤ 50 years of age in Taiwan. We also revealed that anti-VEGF treatment is highly effective in the treatment of CNV in this age group.
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A randomized trial of intravitreal bevacizumab vs. ranibizumab for myopic CNV. Graefes Arch Clin Exp Ophthalmol 2014; 253:1867-72. [DOI: 10.1007/s00417-014-2886-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022] Open
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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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Ho M, Liu DTL, Young AL, Lam DSC. Management of Choroidal Neovascularization Secondary to Pathological Myopia: The Era of Changes. Asia Pac J Ophthalmol (Phila) 2014; 3:94-103. [PMID: 26107492 DOI: 10.1097/apo.0000000000000017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Choroidal neovascularization (CNV) secondary to pathological myopia is an important cause of significant visual impairment in young adults. High myopia is particularly prevalent in Asian population. New scientific contributions have been made to the understanding of high myopia and myopic CNV. Treatment for myopic CNV has previously relied on photodynamic therapy, laser photocoagulation, and submacular surgery. The treatment outcomes from these modalities are, however, controversial. The introduction of antiangiogenic agents including bevacizumab and ranibizumab has brought the treatment of myopic CNV into a new era. The purpose of this review was to provide an overview of the natural history of myopic CNV, the prognostic factors, and the various treatment options including laser photocoagulation and photodynamic therapy, with particular attention on antiangiogenic agents.
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Affiliation(s)
- Mary Ho
- From the *Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China; and †Dennis Lam and Partners Eye Center, Central Building, Central, Hong Kong, People's Republic of China
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Pece A, Isola V, Vitale L. Management of choroidal neovascularization in myopic macular degeneration. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.3.3.311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Barbazetto IA, Takahashi BS. Verteporfin photodynamic therapy in the age of antiangiogenic therapy. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.3.4.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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17
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Varano M, Iacono P, Giorno P, Chiaravalloti A, Parravano M. Photodynamic Therapy in Subfoveal and Juxtafoveal Myopic Choroidal Neovascularization: A 10-year Retrospective Analysis. Ophthalmologica 2014; 231:204-10. [DOI: 10.1159/000357504] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 11/18/2013] [Indexed: 11/19/2022]
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18
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Wang JH, Jiang W, Kang ZF. Reply to: Effect of axial length on myopic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol 2013; 251:2271. [DOI: 10.1007/s00417-012-2251-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022] Open
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Oh HN, Lee JE, Kim HW, Yun IH. Predictive Factors for Visual Outcome after Treatment for Myopic Choroidal Neovascularization. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.4.610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ha Na Oh
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Joo Eun Lee
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyun Woong Kim
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Il Han Yun
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Neelam K, Cheung CMG, Ohno-Matsui K, Lai TYY, Wong TY. Choroidal neovascularization in pathological myopia. Prog Retin Eye Res 2012; 31:495-525. [PMID: 22569156 DOI: 10.1016/j.preteyeres.2012.04.001] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 04/13/2012] [Accepted: 04/16/2012] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Kumari Neelam
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
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Ng DS, Kwok AKH, Chan CW. Anti-vascular endothelial growth factor for myopic choroidal neovascularization. Clin Exp Ophthalmol 2012; 40:e98-e110. [PMID: 21902785 DOI: 10.1111/j.1442-9071.2011.02684.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Danny S Ng
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
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22
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Silva R. Myopic Maculopathy: A Review. Ophthalmologica 2012; 228:197-213. [DOI: 10.1159/000339893] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 05/27/2012] [Indexed: 11/19/2022]
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23
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Photothérapie dynamique sous huile de silicone pour traiter des néovaisseaux choroïdiens du myope fort. J Fr Ophtalmol 2011; 34:561.e1-4. [DOI: 10.1016/j.jfo.2011.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 12/25/2010] [Indexed: 11/20/2022]
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El Matri L, Kort F, Chebil A, Bouraoui R, Merdassi A, Bouladi M. Intravitreal bevacizumab versus photodynamic therapy for myopic choroidal neovascularization in a North-African population. Graefes Arch Clin Exp Ophthalmol 2011; 249:1287-93. [PMID: 21484465 DOI: 10.1007/s00417-011-1654-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 01/04/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To compare the 1-year functional and anatomical outcomes of intravitreal bevacizumab (IVB) and photodynamic therapy (PDT) in patients with myopic choroidal neovascularization (CNV). METHODS Review of retrospectively collected data of 80 eyes in 80 patients with myopic CNV treated with standard PDT (n = 40) or IVB (1.25 mg/ 0.05 ml) (n = 40). Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) measured with optical coherence tomography (OCT) were compared between the two groups at baseline, 3, 6 and 12 months. RESULTS In the IVB group, mean BCVA was +0.9 ± 0.85 logMAR at baseline. Mean BCVA was significantly better at 3 and 6 months than baseline (p = .0095 and p = .008, respectively) but not at 12 months (p = .065). In the PDT group, mean BCVA was +0.88 ± 0.45 logMAR at baseline, and improved to +0.85 ± 0.62 logMAR at 3 months and to +0.86 ± 0.44 logMAR at 6 months, which was not significantly different from baseline. Mean BCVA then decreased to +0.9 ± 0.54 logMAR at 12 months (p = .85). Mean logMAR VA was significantly better in the IVB group than in the PDT group after 3 months (p = .0043), 6 months (p = .0001) and 12 months (p = .0168). Mean CRT was significantly lower in IVB group than in PDT group at 3, 6 and 12 months (p = .008, p = .038, p = .040, respectively). Chorioretinal atrophy developed in six eyes (15%) treated with IVB and in 24 eyes (60%) treated with PDT at 12 months (p = 3.2 × 10(-5)). CONCLUSIONS Over a 12-month period, intravitreal bevacizumab seems to be superior to photodynamic therapy in controlling myopic CNV in a North-African population.
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Affiliation(s)
- Leila El Matri
- Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Boulevard 9 Avril 1006 Bab Saadoun, Tunis, Tunisia.
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Hayashi K, Ohno-Matsui K, Shimada N, Moriyama M, Hayashi W, Wang J, Yoshida T, Tokoro T, Mochizuki M. Long-term results of photodynamic therapy for choroidal neovascularization in Japanese patients with pathologic myopia. Am J Ophthalmol 2011; 151:137-147.e1. [PMID: 20970774 DOI: 10.1016/j.ajo.2010.06.046] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 06/30/2010] [Accepted: 06/30/2010] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To determine the results of photodynamic therapy (PDT) in highly myopic eyes with choroidal neovascularization (CNV). DESIGN Open-label, consecutive, interventional case series. METHODS Forty-eight eyes of 46 consecutive Japanese patients with a myopic CNV were studied. The eyes were treated with PDT and were followed up from 1 to 4 years. The best-corrected visual acuities (BCVAs) at the baseline and after the PDT were compared. Multivariate regression analyses were used to determine the factors that were significantly associated with the BCVA at 3 or 4 years. RESULTS The mean follow-up period was 3.2 years. Sixty-nine percent of the patients obtained angiographic closure by a single PDT treatment, and the average number of PDT treatments was 1.4. Chorioretinal atrophy developed in 61% of the eyes at 3 years and in 70% of the eyes at 4 years. The BCVA did not change significantly after the PDT. Multivariate regression analyses showed that the BCVA at 3 years was significantly correlated with the baseline BCVA and area of chorioretinal atrophy. Analyses of the 20 patients at 4 years or more showed that in 5 of 7 (71.4%) patients with juxtafoveal CNV, chorioretinal atrophy did not develop and that all had BCVA of 0.5 or better. However, in 12 of the 13 patients with a subfoveal CNV, chorioretinal atrophy developed at 4 years, and 10 of these patients had BCVA of 0.1 or worse. CONCLUSIONS In highly myopic patients, 69% obtained angiographic closure by a single PDT treatment, and recurrence was rare. These findings indicate that PDT is still a good option for treating CNVs in highly myopic patients.
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Affiliation(s)
- Kengo Hayashi
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Japan
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26
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Ikuno Y, Nagai Y, Matsuda S, Arisawa A, Sho K, Oshita T, Takahashi K, Uchihori Y, Gomi F. Reply. Am J Ophthalmol 2010. [DOI: 10.1016/j.ajo.2010.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Campa C, Harding SP. Two-year visual results for older asian women treated with photodynamic therapy or bevacizumab for myopic choroidal neovascularization. Am J Ophthalmol 2010; 149:1014-5; author reply 1015-6. [PMID: 20510692 DOI: 10.1016/j.ajo.2010.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 02/24/2010] [Indexed: 10/19/2022]
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Nabawi KS, Shaarawi AS. Transpupillary Thermotherapy of Subfoveal Choroidal Neovascularization Secondary to Pathologic Myopia. Ophthalmic Surg Lasers Imaging Retina 2010; 41:12-7. [DOI: 10.3928/15428877-20091230-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2009] [Indexed: 11/20/2022]
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Besozzi G, Sborgia L, Furino C, Cardascia N, Dammacco R, Sborgia G, Modoni AP, Boscia F. Low-fluence-rate photodynamic therapy to treat subfoveal choroidal neovascularization in pathological myopia. A study of efficacy and safety. Graefes Arch Clin Exp Ophthalmol 2009; 248:497-502. [PMID: 19916015 DOI: 10.1007/s00417-009-1232-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 10/20/2009] [Accepted: 10/22/2009] [Indexed: 10/20/2022] Open
Abstract
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.
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Affiliation(s)
- Gianluca Besozzi
- Department of Ophthalmology and ENT, University of Bari, Piazza Giulio Cesare, 11-70124 Bari, Italy
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ANTI-VEGF DRUGS AS THE 2009 FIRST-LINE THERAPY FOR CHOROIDAL NEOVASCULARIZATION IN PATHOLOGIC MYOPIA. Retina 2009; 29:1062-6. [DOI: 10.1097/iae.0b013e3181b1bb1a] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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31
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Intravitreal bevacizumab for CNV-complicated tilted disk syndrome. Graefes Arch Clin Exp Ophthalmol 2009; 247:1179-82. [DOI: 10.1007/s00417-009-1096-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 04/07/2009] [Accepted: 04/13/2009] [Indexed: 11/27/2022] Open
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Costagliola C, Campa C, Incorvaia C, Parmeggiani F, Menzione M, Della Corte M, Rinaldi M, Romano M, Semeraro F. Verteporfin photodynamic therapy for subfoveal choroidal neovascularization in pathologic myopia: a 12-month retrospective review. Eur J Ophthalmol 2009; 18:955-9. [PMID: 18988168 DOI: 10.1177/112067210801800616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the visual outcome of patients with subfoveal choroidal neovascularization (CNV) secondary to pathologic myopia treated with verteporfin photodynamic therapy (PDT-V) and to verify the predictive role of visual and angiographic parameters. METHODS This is a retrospective, interventional, consecutive case series study of subjects with subfoveal CNV secondary to pathologic myopia. All patients received PDT-V according to VIP guidelines. A complete ophthalmologic evaluation was performed on all patients and included best-corrected visual acuity (BCVA), fundus examination, and fluorescein angiography (FA, IMAGEnet System, Topcon Corp., Japan). CNV size (mm2) was directly measured on the early phase of the angiogram using the software included with the IMAGEnet package. All checks were scheduled at 3-month intervals for a period of 1 year. A review of medical and angiographic records was performed and assessed throughout a 12-month follow-up period. RESULTS A total of 62 patients (62 eyes) were examined. Best-corrected visual acuity (BCVA) moderately decreased without reaching a statistically noticeable level throughout the followup; reduction in lesion size reached a significant level at the second checkup. A significant correlation between higher baseline BCVA and better final visual outcome was detected. CONCLUSIONS Standardized PDT-V minimizes central vision deterioration in patients with CNV secondary to pathologic myopia. Better BCVA at presentation represents a good predictive sign.
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Affiliation(s)
- C Costagliola
- Dipartimento di Scienze per la Salute, Università degli Studi del Molise, Campobasso - Italy.
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Ryu JW, Cho HK, Lee WK. Short-Term Effect of Intravitreal Bevacizumab Injection for Choroidal Neovascularization Associated With Degenerative Myopia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.9.1334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jeong-Wan Ryu
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Kyung Cho
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won-Ki Lee
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Stur M. Indikationen für photodynamische Therapie mit Verteporfin im Zeitalter der intravitrealen Therapie – eine Übersicht. SPEKTRUM DER AUGENHEILKUNDE 2008. [DOI: 10.1007/s00717-008-0294-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pece A, Isola V. Retinal pigment epithelial marginal retraction after photodynamic therapy for choroidal neovascularization in pathologic myopia. Eur J Ophthalmol 2008; 18:841-4. [PMID: 18850572 DOI: 10.1177/112067210801800533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the incidence of retinal pigment epithelial (RPE) marginal retraction after verteporfin photodynamic therapy (PDT) for subfoveal choroidal neovascularization (CNV) in pathologic myopia (PM). METHODS Retrospective review of 236 patients treated with PDT for subfoveal CNV due to PM. RESULTS RPE marginal retraction was found in 3 eyes (1.3%), and a decrease of a mean of five lines of vision was reported to occur 10-15 days after treatment. At the end of followup two eyes lost three lines and one six lines from baseline. CONCLUSIONS RPE marginal retraction as an early complication of PDT for subfoveal CNV secondary to PM is rare. The low incidence of this adverse event, however, should not preclude recommendations for PDT in myopic eyes that could benefit from this treatment modality.
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Affiliation(s)
- A Pece
- Department of Ophthalmology, Melegnano Hospital, Milano - Italy.
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Wu PC, Chen YJ, Chen CH, Chen YH, Kao ML, Shin SJ, Ko YM, Kuo HK. Subthreshold transpupillary thermotherapy in Chinese patients with myopic choroidal neovascularization: one and two year follow-up. Clin Exp Ophthalmol 2008. [DOI: 10.1111/j.1442-9071.2008.01783.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hayashi K, Ohno-Matsui K, Teramukai S, Shimada N, Moriyama M, Hara W, Yoshida T, Tokoro T, Mochizuki M. Photodynamic therapy with verteporfin for choroidal neovascularization of pathologic myopia in Japanese patients: comparison with nontreated controls. Am J Ophthalmol 2008; 145:518-526. [PMID: 18207125 DOI: 10.1016/j.ajo.2007.10.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 10/28/2007] [Accepted: 10/30/2007] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine the effects of photodynamic therapy (PDT) with verteporfin on subfoveal or juxtafoveal choroidal neovascularization (CNV) secondary to pathologic myopia in Japanese patients and to compare the visual outcomes of PDT-treated patients with that of age-matched and visual acuity-matched untreated controls. DESIGN Prospective, open-label, consecutive, interventional case series. METHODS We prospectively followed up 43 eyes of 42 consecutive patients with pathologic myopia (>6 diopters or axial length>26.5 mm) who received PDT for myopic CNV. In addition, the visual outcomes of these patients who were followed up for more than one year were compared with those of age- and initial visual acuity-matched untreated controls. RESULTS The average follow-up was 15.0+/-7.0 months. Patients received an average of 1.40+/-0.73 treatments during follow-up, and 30 eyes (69.8%) required only one treatment. The best-corrected visual acuity (BCVA) improved by more than two Snellen lines in seven eyes (16.3%), decreased in six eyes (14.0%), and remained stable in 30 eyes (69.7%). In three eyes with a juxtafoveal CNV, CNV could not be detected ophthalmoscopically or angiographically after PDT. Statistical analysis showed that the PDT-treated patients had significantly better visual acuity at one year after PDT than the age- and initial BCVA-matched untreated controls. CONCLUSIONS These results indicate that PDT was beneficial for maintaining vision in Japanese patients with myopic CNV. The visual outcome after PDT was better than the natural course of the disease as determined from untreated controls. The effect on chorioretinal atrophy around CNV should be investigated with a long-term study.
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Pece A, Vadalà M, Isola V, Matranga D. Photodynamic therapy with verteporfin for juxtafoveal choroidal neovascularization in pathologic myopia: a long-term follow-up study. Am J Ophthalmol 2007; 143:449-54. [PMID: 17317390 DOI: 10.1016/j.ajo.2006.11.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2006] [Revised: 10/29/2006] [Accepted: 11/14/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the effect of verteporfin photodynamic therapy (PDT) in juxtafoveal choroidal neovascularization (CNV) secondary to pathologic myopia (PM). DESIGN Prospective, open-label, consecutive, interventional case series. METHODS We prospectively followed a series of 48 consecutive patients (49 eyes) with pathologic myopia (> or = 6 diopters) who received verteporfin PDT for juxtafoveal CNV. This population was divided into two groups based on age (group A < or = 55 years old, group B >55 years old), in three subgroups based on CNV lesion size, and in three categories based on refractive error at baseline. RESULTS The median follow-up was 32 months (range, 12 to 56 months). Visual acuity (VA) improved by 1 or more Snellen lines in 18 eyes (37%), decreased in 12 eyes (24%), and remained stable in 19 eyes (39%). The median number of lines gained was 2.15, while the median number of lines lost was 2.4. The final mean VA in group A (mean age, 43.9 years) was 20/50 (logMAR 0.41, standard deviation [SD] 0.3) and significantly better (P = .01) than the 20/105 (logMAR 0.72, SD 0.5) in group B (mean age, 67.8 years). Neither CNV size nor refractive error magnitude influenced visual outcomes. CONCLUSION Verteporfin PDT is a promising treatment modality resulting in stable or improved vision in 76% of the myopic eyes with juxtafoveal CNV. Younger patients appear to respond more favorably to treatment.
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Affiliation(s)
- Alfredo Pece
- Department of Ophthalmology, Melegnano Hospital, Milan, Italy.
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