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Woronkowicz M, Hamilton R, Lightman S, Zagora S, Tomkins-Netzer O. Comparison of anatomical and functional outcomes of treating myopic choroidal neovascularization with bevacizumab or ranibizumab. Int Ophthalmol 2023; 43:3499-3507. [PMID: 37318668 DOI: 10.1007/s10792-023-02755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/21/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE To compare results of treatment with bevacizumab and ranibizumab injections in myopic choroidal neovascularization (mCNV). METHODS Retrospective, observational case series. PARTICIPANTS patients with mCNV treated with bevacizumab or ranibizumab injections. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) on optical coherence tomography (OCT) scans were collected at baseline, after 3, 6, 12, 24 months and the last visit. MAIN OUTCOME MEASURES mean change in BCVA and CRT. RESULTS We included 85 eyes treated with bevacizumab and 125 eyes treated with ranibizumab. There was no difference between the groups regarding BCVA and CRT change. CNV recurrence occurred at the mean time of 66.1 ± 3.7 and 57.3 ± 6.4 months in the bevacizumab- and ranibizumab-treated eyes, respectively (p = 0.006). During the first year 6.9% eyes in the bevacizumab group vs. 27.5% in the ranibizumab group had CNV recurrence (p = 0.001). Risk factors for recurrence of CNV were baseline CNV area (aHR 1.20, 95%CI 1.0-1.32, p = 0.04), subfoveal CNV (aHR 2.13, 95% CI 1.16-3.93, p = 0.01) and ranibizumab treatment (aHR 2.31, 95% CI 1.16-3.93, p = 0.008). CONCLUSION Eyes treated with bevacizumab and ranibizumab can achieve similar anatomical and functional improvement. CNV recurrence may occur earlier and more frequently during the first year in eyes treated with ranibizumab.
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Affiliation(s)
- Malgorzata Woronkowicz
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.
- UCL Institute of Ophthalmology, London, UK.
| | - Robin Hamilton
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, London, UK
| | - Sue Lightman
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, London, UK
| | - Sophia Zagora
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
- Sydney Eye Hospital, Sydney, Australia
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, London, UK
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Huang CJ, Hsia Y, Wang SW, Ma IH, Tsui MC, Hung KC, Ho TC. Characteristics and response of subretinal hyperreflective material to anti-vascular endothelial growth factor in myopic choroidal neovascularization. Sci Rep 2023; 13:5431. [PMID: 37012311 PMCID: PMC10070346 DOI: 10.1038/s41598-023-32417-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
This retrospective study evaluated the characteristics and response of subretinal hyperreflective material (SHRM) to anti-vascular endothelial growth factor (VEGF) treatment in eyes with myopic choroidal neovascularization (CNV). The visual acuity (VA) was assessed at 3, 6, and 12 months after initiating anti-VEGF treatment in 116 patients (119 eyes) with SHRM and myopic CNV. Multimodal imaging, including color fundus photography, fluorescein angiography (FA), and optical coherence tomography angiography (OCT-A), were performed. We compared type 2 neovascularization (NV) (n = 64), subretinal hyperreflective exudation (SHE) (n = 37), NV with hemorrhage (n = 15), and fibrosis (n = 3). The type 2 NV group, and NV with hemorrhage groups showed significant VA improvement after 12 months of treatment (p < 0.05 in both groups); the SHE group failed to show improvement (p = 0.366). All groups showed a significant reduction in central foveal thickness after 12 months of treatment (all p < 0.05). The SHE group had a significantly higher incidence of interrupted ellipsoid zone than the other groups (p < 0.05). Myopic CNV can present as SHRM on OCT-A. Visual prognoses vary in different SHRM types. OCT-A and FA may help predict the outcomes of different subtypes of myopic CNV. SHE is predictive of outer retinal layer atrophy in patients with various SHRM types.
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Affiliation(s)
- Chien-Jung Huang
- Department of Ophthalmology, Fu Jen University Hospital, New Taipei City, Taiwan
| | - Yun Hsia
- Department of Ophthalmology, College of Medicine, National Taiwan University Hospital, National Taiwan University, No. 7, Chung-Shan S. Rd., Taipei City, 10002, Taiwan
- Department of Ophthalmology, National Taiwan University Biomedical Park Hospital, National Taiwan University Hospital Hsinchu Branch, HsinChu County, Zhubei City, Taiwan
| | - Shih-Wen Wang
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - I-Hsin Ma
- Department of Ophthalmology, National Taiwan University Biomedical Park Hospital, National Taiwan University Hospital Hsinchu Branch, HsinChu County, Zhubei City, Taiwan
| | - Mei-Chi Tsui
- Department of Ophthalmology, College of Medicine, National Taiwan University Hospital, National Taiwan University, No. 7, Chung-Shan S. Rd., Taipei City, 10002, Taiwan
| | | | - Tzyy-Chang Ho
- Department of Ophthalmology, College of Medicine, National Taiwan University Hospital, National Taiwan University, No. 7, Chung-Shan S. Rd., Taipei City, 10002, Taiwan.
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Mazzola M, Premoli L, Metrangolo C, Cattaneo J, Premi E, Donati S, Azzolini C. Myopic Simple Hemorrhage Presenting as Radial Hemorrhage in Henle's Fiber Layer. Case Rep Ophthalmol 2021; 12:446-450. [PMID: 34177540 PMCID: PMC8216004 DOI: 10.1159/000510626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/01/2020] [Indexed: 11/19/2022] Open
Abstract
This case report describes a simple hemorrhage (SH) presenting as radial hemorrhage in Henle's fiber layer (HFL) in a patient with high myopia. A 26-year-old girl with high myopia was referred to our center for sudden onset of decreased vision and a central scotoma in the right eye (OD). Best corrected visual acuity (BCVA) was 20/100 OD. Fundus examination showed a stellate intraretinal hemorrhage in the fovea of the OD. The hemorrhage was organized in a peculiar petaloid pattern with feathery distal edges, suggesting localization within the radially oriented HFL. The presence of both choroidal neovascularization and microvascular abnormalities consistent with macular telangiectasia type 2 (MacTel 2) were excluded. Based on these findings, a diagnosis of myopic SH was made. At 4-month follow-up BCVA OD spontaneously improved to 20/40, without any treatment been ever administered to the patient. Spectral-domain optical coherence tomography OD showed reabsorption of the hemorrhage and almost complete restoration of the foveal architecture. The intraretinal location and spread of the hemorrhage into the HFL in our patient are an unusual presentation of SH, which vividly highlights the anatomy of the fovea. Since fibers in HFL are quite delicate and loosely arranged, this layer is very susceptible to deposition of transudates, exudates, hemorrhage, and other products. Radial hemorrhage in HFL has been originally reported in 4 patients as complication of MacTel 2. It has been previously postulated that it may represent a characteristic finding in MacTel 2 that may develop as a result of microvascular abnormalities of the deep retinal capillary plexus. On the contrary, our data suggest that radial hemorrhage in the HFL does not represent a characteristic finding of MacTel 2, but must rather be considered a non-specific sign with multiple possible etiologies.
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Affiliation(s)
- Marco Mazzola
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy.,Ophthalmology Department, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Laura Premoli
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Cristian Metrangolo
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Jennifer Cattaneo
- Ophthalmology Clinic, Department of Neuroscience, ASST Ovest Milanese, Legnano, Italy
| | - Elias Premi
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Simone Donati
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Claudio Azzolini
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
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Ren P, Lu L, Tang X, Lu H, Zhao Y, Lou D, Han W. Clinical features of simple hemorrhage and myopic choroidal neovascularization associated with lacquer cracks in pathologic myopia. Graefes Arch Clin Exp Ophthalmol 2020; 258:2661-2669. [PMID: 32648154 DOI: 10.1007/s00417-020-04778-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To investigate the clinical features of simple hemorrhage (SH) and myopic choroidal neovascularization (mCNV) lesions in pathologic myopia (PM) accompanied with lacquer cracks (LCs). METHODS Altogether 105 PM subjects were recruited with fifty-eight eyes categorized as group LC + SH and sixty eyes as group LC + mCNV. LCs were categorized into stellate and linear subtypes. Eye fundus photography, optical coherence tomography, fluorescein angiography, and indocyanine green angiography were performed. Clinical demographic data, PM maculopathy, peripapillary atrophy, and macular choroidal thickness (mCT) were documented. RESULTS Significant differences in age, gender, BCVA, and PM atrophies were observed between LC + SH and LC + mCNV groups. The stellate LC was more common in elder subjects with more severe chorioretinal atrophy and thinner mCT compared with linear LCs (P < 0.05). The mCT in group LC + SH was significantly larger than group LC + CNV (P < 0.001), especially in temporal, inferior, and superior locations of macula. The mCT showed correlation with age (P < 0.001)with a decreasing rate of 0.696 μm/year. CONCLUSIONS SH tended to initially occur in younger subjects with linear LCs. mCNV was more common in elder subjects with severe chorioretinal atrophy. Stellate LCs were associated with the worse PM lesions.
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Affiliation(s)
- Peifang Ren
- Department of Ophthalmology, the First Affiliated Hospital, School of Medicine
- , Zhejiang University, 79 Qingchun Road, Zhejiang, 310003, Hangzhou, China
| | - Li Lu
- Department of Ophthalmology, the First Affiliated Hospital, School of Medicine
- , Zhejiang University, 79 Qingchun Road, Zhejiang, 310003, Hangzhou, China
| | - Xuyuan Tang
- Department of Ophthalmology, the First Affiliated Hospital, School of Medicine
- , Zhejiang University, 79 Qingchun Road, Zhejiang, 310003, Hangzhou, China
| | - Hong Lu
- Department of Ophthalmology, the First Affiliated Hospital, School of Medicine
- , Zhejiang University, 79 Qingchun Road, Zhejiang, 310003, Hangzhou, China
| | - Yuan Zhao
- Department of Ophthalmology, the First Affiliated Hospital, School of Medicine
- , Zhejiang University, 79 Qingchun Road, Zhejiang, 310003, Hangzhou, China
| | - Dinghua Lou
- Department of Ophthalmology, the First Affiliated Hospital, School of Medicine
- , Zhejiang University, 79 Qingchun Road, Zhejiang, 310003, Hangzhou, China.
| | - Wei Han
- Department of Ophthalmology, the First Affiliated Hospital, School of Medicine
- , Zhejiang University, 79 Qingchun Road, Zhejiang, 310003, Hangzhou, China.
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Long-Term Natural Outcomes of Simple Hemorrhage Associated with Lacquer Crack in High Myopia: A Risk Factor for Myopic CNV? J Ophthalmol 2018; 2018:3150923. [PMID: 29619253 PMCID: PMC5829355 DOI: 10.1155/2018/3150923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 12/06/2017] [Accepted: 12/26/2017] [Indexed: 12/03/2022] Open
Abstract
Purpose To investigate the relationship between simple hemorrhage (SH) associated with lacquer crack (LC) and myopic choroidal neovascularization (CNV) in high myopia. Methods A cross-sectional evaluation including best-corrected visual acuity (BCVA), axial length, refractive error, color fundus photography, and spectral domain optical coherence tomography (SD-OCT) was performed in patients diagnosed with high myopia and SH. Fundus fluorescein angiography and indocyanine green angiography were performed if the eye was suspected with CNV. Results Thirty-three eyes of 27 patients with SH were enrolled in the study. None of the eyes developed CNV at final examination following the occurrence of hemorrhage. Recurrent hemorrhage was observed in 36.5% of the eyes. Compared with the initial BCVA, the final BCVA was significantly improved (P < 0.001) and correlated with the integrity of the ellipsoid zone in SD-OCT. There was no significant difference in the final BCVA between group 1 (LC crossed the central fovea) and group 2 (no LC crossed the central fovea) (P = 0.299). Conclusions SH associated with LC is not a risk factor for the development of myopic CNV in patients with high myopia. LCs have little influence on the final BCVA unless the integrity of the ellipsoid zone in the central fovea is disrupted.
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Reply. Retina 2018; 38:e3-e4. [DOI: 10.1097/iae.0000000000001975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cheung CMG, Arnold JJ, Holz FG, Park KH, Lai TY, Larsen M, Mitchell P, Ohno-Matsui K, Chen SJ, Wolf S, Wong TY. Myopic Choroidal Neovascularization. Ophthalmology 2017; 124:1690-1711. [DOI: 10.1016/j.ophtha.2017.04.028] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 04/03/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023] Open
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Ohno-Matsui K, Lai TY, Lai CC, Cheung CMG. Updates of pathologic myopia. Prog Retin Eye Res 2016; 52:156-87. [DOI: 10.1016/j.preteyeres.2015.12.001] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 12/20/2022]
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