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Sakata R, Miyata M, Ooto S, Tamura H, Ueda-Arakawa N, Muraoka Y, Miyake M, Hata M, Takahashi A, Kido A, Numa S, Mori Y, Tsuda K, Uji A, Oishi A, Tsujikawa A. TEN-YEAR VISUAL OUTCOME AND CHANGE IN CHORIORETINAL ATROPHY AFTER INTRAVITREAL RANIBIZUMAB FOR MACULAR NEOVASCULARIZATION IN PATHOLOGIC MYOPIA. Retina 2023; 43:1863-1871. [PMID: 37339449 DOI: 10.1097/iae.0000000000003869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
PURPOSE To investigate the 10-year visual outcome and chorioretinal atrophy after a single intravitreal ranibizumab injection followed by a pro re nata regimen for myopic macular neovascularization in pathologic myopia, and to identify the factors associated with 10-year best-corrected visual acuity (BCVA). METHODS This retrospective observational study evaluated 26 consecutive treatment-naïve eyes (26 patients) with myopic macular neovascularization in pathologic myopia who underwent a single intravitreal ranibizumab followed by a pro re nata regimen of intravitreal ranibizumab and/or intravitreal aflibercept injection and observed over 10 years. We assessed changes in BCVA and morphological parameters, including the META-PM Study category as a chorioretinal atrophy index. RESULTS The logarithm of the minimum angle of resolution BCVA changed from 0.36 (Snellen, 20/45) ± 0.39 to 0.39 (20/49) ± 0.36 over 10 years of observation. Compared to baseline, 1-year BCVA improved ( P = 0.002), whereas 2 to 10-year BCVA was not significantly different. Total injection frequency was 3.8 ± 2.6. In none of the eyes, 10-year BCVA was 20/200 or less. Ten-year BCVA correlated with baseline BCVA ( P = 0.01, r = 0.47). The META-PM Study category progressed in 60% of eyes. There were no drug-induced complications. CONCLUSION Best-corrected visual acuity in eyes with myopic macular neovascularization in pathologic myopia was maintained for 10 years after a single intravitreal ranibizumab followed by a pro re nata regimen without drug-induced complications. The META-PM Study category progressed in 60% of eyes, especially those with older baseline age. Early diagnosis and treatment of myopic macular neovascularization are essential to maintain good long-term BCVA.
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Affiliation(s)
- Ryo Sakata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City, Japan; and
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City, Japan; and
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City, Japan; and
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City, Japan; and
| | - Naoko Ueda-Arakawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City, Japan; and
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City, Japan; and
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City, Japan; and
| | - Masayuki Hata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City, Japan; and
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City, Japan; and
| | - Ai Kido
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City, Japan; and
| | - Shogo Numa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City, Japan; and
| | - Yuki Mori
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City, Japan; and
| | - Kanae Tsuda
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City, Japan; and
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City, Japan; and
| | - Akio Oishi
- Department of Ophthalmology and Visual Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City, Japan; and
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RISK FACTORS OF VISION LOSS AND MULTIPLE RECURRENCES IN MYOPIC MACULAR NEOVASCULARIZATION. Retina 2023; 43:275-285. [PMID: 36368028 DOI: 10.1097/iae.0000000000003673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To investigate the factors associated with maximum visual improvement (peak vision) gain and the risk factors of peak vision loss and multiple recurrences in myopic macular neovascularization undergoing antivascular endothelial growth factor therapy. METHODS Retrospective study of 310 eyes with active myopic macular neovascularization and median follow-up of 3.5 years. We defined peak vision gain as the maximum best-corrected visual acuity value reached under treatment and peak vision loss as best-corrected visual acuity never scoring as peak vision. We used multiple-event Prentice, Williams, and Peterson models to compute recurrences' incidence and Cox regression to identify risk factors for peak vision gain, peak vision loss, and multiple recurrences. RESULTS Eyes with worse baseline best-corrected visual acuity {hazard ratio (HR) = 2.59 (95% confidence interval [CI]: 1.63-4.11) for 0.1 logMAR increase, P < 0.001} had higher chance to achieve peak vision. Peak vision was lost in 162 eyes (52%). Older age (HR = 1.22 [95% CI: 1.02-1.43] for 10-year increase, P = 0.02) and recurrences (HR = 1.10 [95% CI: 1.01-1.22] for event, P = 0.04) predicted nonsustained peak vision. Older age (HR = 1.13 [95% CI: 1.04-1.27] for 10-year increase, P = 0.006), larger myopic macular neovascularization (HR = 1.06 [95% CI: 1.01-1.13] for 1-mm 2 increase, P = 0.04), and juxtafoveal location (HR = 1.88 [95% CI: 1.28-2.77] vs. extrafoveal, P = 0.001) predicted multiple recurrences. CONCLUSION Myopic macular neovascularization eyes lose vision mainly because of multiple recurrences. Patients at risk for recurrences should undergo more attentive monitoring to avoid vision loss.
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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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Response to treatment of choroidal neovascularization in highly myopic eyes with dome-shaped macula: 2 years of follow-up. Retina 2022; 42:1057-1064. [PMID: 35174804 DOI: 10.1097/iae.0000000000003431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE to compare the two-year outcome to anti-VEGF therapy for myopic choroidal neovascularization (CNV) in eyes with or without dome-shaped macula (DSM). METHODS data from treatment-naïve myopic CNV with a two-years follow-up were retrospectively collected and divided in two groups according to the presence of DSM. Best corrected visual acuity (BCVA) was acquired at baseline, 3, 12 and 24 months. The association between visual outcomes and CNV type and area, presence of scleral-derived feeder vessel, macular atrophy and lacquer cracks at baseline was also evaluated. RESULTS 54 eyes of 54 patients were included; 18 eyes (33.4%) had DSM. CNV was foveal in 10 DSM eyes (55.6%) and in 30 non-DSM eyes (83.9%), p=0.033. At baseline, the mean BCVA was significantly higher in the DSM group (68.33±12.04 ETDRS letters, 20/40 Snellen) compared to the non-DSM group (57.75±13.46 ETDRS letters, 20/72 Snellen; p=0.007). This difference disappeared after 3 months and did not reoccur afterwards. All other parameters were not significantly associated with visual outcomes. CONCLUSIONS overall, DSM does not represent a negative prognostic factor in response to anti-VEGF therapy in myopic CNVs after two years. However, in DSM eyes, CNVs tend to be extra-foveal, thus ensuring a good visual prognosis from the earliest stage of the disease.
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Ng DSC, Ho M, Iu LPL, Lai TYY. Safety review of anti-VEGF therapy in patients with myopic choroidal neovascularization. Expert Opin Drug Saf 2021; 21:43-54. [PMID: 34228553 DOI: 10.1080/14740338.2021.1952979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Anti-angiogenesis therapy with intravitreal anti-VEGF agents is now the standard-of-care treatment for myopic choroidal neovascularization (CNV). AREAS COVERED We provide a critical review of the safety of all the anti-VEGF agents currently used for treating myopic CNV including ranibizumab, aflibercept, conbercept, bevacizumab, and ziv-aflibercept. EXPERT OPINION Anti-VEGF therapy for myopic CNV with the currently available anti-VEGF drugs generally have favorable safety outcomes in the short-term. Nonetheless, ocular adverse events following anti-VEGF therapy for myopic CNV may develop and these include worsening or new development of myopic traction maculopathy, increased risk of retinal detachment, and progression of chorioretinal atrophy. Clinicians should be aware of these potential complications and evaluate them before and after anti-VEGF therapy.
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Affiliation(s)
- Danny S C Ng
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Mary Ho
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, New Territories, Hong Kong
| | - Lawrence P L Iu
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, New Territories, Hong Kong
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,2010 Retina and Macula Centre, Kowloon, Hong Kong
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Ng DSC, Fung NSK, Yip FLT, Lai TYY. Ranibizumab for myopic choroidal neovascularization. Expert Opin Biol Ther 2020; 20:1385-1393. [DOI: 10.1080/14712598.2021.1830969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Nicholas S. K. Fung
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Po Fu Lam, Hong Kong
| | | | - Timothy Y. Y. Lai
- The Chinese University of Hong Kong, Kowloon, Hong Kong
- 2010 Retina and Macula Centre, Tsim Sha Tsui, Hong Kong
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Sogawa T, Tabuchi H, Nagasato D, Masumoto H, Ikuno Y, Ohsugi H, Ishitobi N, Mitamura Y. Accuracy of a deep convolutional neural network in the detection of myopic macular diseases using swept-source optical coherence tomography. PLoS One 2020; 15:e0227240. [PMID: 32298265 PMCID: PMC7161961 DOI: 10.1371/journal.pone.0227240] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/29/2020] [Indexed: 12/20/2022] Open
Abstract
This study examined and compared outcomes of deep learning (DL) in identifying swept-source optical coherence tomography (OCT) images without myopic macular lesions [i.e., no high myopia (nHM) vs. high myopia (HM)], and OCT images with myopic macular lesions [e.g., myopic choroidal neovascularization (mCNV) and retinoschisis (RS)]. A total of 910 SS-OCT images were included in the study as follows and analyzed by k-fold cross-validation (k = 5) using DL's renowned model, Visual Geometry Group-16: nHM, 146 images; HM, 531 images; mCNV, 122 images; and RS, 111 images (n = 910). The binary classification of OCT images with or without myopic macular lesions; the binary classification of HM images and images with myopic macular lesions (i.e., mCNV and RS images); and the ternary classification of HM, mCNV, and RS images were examined. Additionally, sensitivity, specificity, and the area under the curve (AUC) for the binary classifications as well as the correct answer rate for ternary classification were examined. The classification results of OCT images with or without myopic macular lesions were as follows: AUC, 0.970; sensitivity, 90.6%; specificity, 94.2%. The classification results of HM images and images with myopic macular lesions were as follows: AUC, 1.000; sensitivity, 100.0%; specificity, 100.0%. The correct answer rate in the ternary classification of HM images, mCNV images, and RS images were as follows: HM images, 96.5%; mCNV images, 77.9%; and RS, 67.6% with mean, 88.9%.Using noninvasive, easy-to-obtain swept-source OCT images, the DL model was able to classify OCT images without myopic macular lesions and OCT images with myopic macular lesions such as mCNV and RS with high accuracy. The study results suggest the possibility of conducting highly accurate screening of ocular diseases using artificial intelligence, which may improve the prevention of blindness and reduce workloads for ophthalmologists.
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Affiliation(s)
- Takahiro Sogawa
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
| | - Hitoshi Tabuchi
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
- Department of Technology and Design Thinking for Medicine, Hiroshima University Graduate School, Hiroshima, Japan
| | - Daisuke Nagasato
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
- Department of Technology and Design Thinking for Medicine, Hiroshima University Graduate School, Hiroshima, Japan
| | - Hiroki Masumoto
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
- Department of Technology and Design Thinking for Medicine, Hiroshima University Graduate School, Hiroshima, Japan
| | | | | | | | - Yoshinori Mitamura
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Long-term outcomes of the intravitreal injection of ranibizumab for the treatment of choroidal neovascularization secondary to pathologic myopia. Int Ophthalmol 2019; 40:833-839. [PMID: 31788714 DOI: 10.1007/s10792-019-01247-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To analyze the long-term outcomes and safety of intravitreal ranibizumab injections in myopic choroidal neovascularization (CNV). METHODS A retrospective non-randomized analysis of consecutive cases included 17 eyes from 17 patients with subfoveal myopic CNV, treated with intravitreal ranibizumab with at least 30-month follow-up. The patients received three injections monthly, followed by pro re nata regimen. Best-corrected visual acuity (BCVA) measurement, optical coherence tomography and fluorescein angiography were carried out at the baseline and at monthly intervals thereafter. RESULTS Mean follow-up period was 51 months (range 30-98 months). In 12 patients (70.6%), BCVA improved by at least 1 Snellen line, with at least 3-line improvement observed in the case of 8 eyes (47%). Mean central foveal thickness (CFT) decreased from 384.65 ± 103.3 µm at the baseline to 264 ± 86.2 µm at the last follow-up examination (p < 0.001). The final OCT examination revealed 59% (10/17) eyes with CNV-related macular atrophy. Mean number of injections over the follow-up period was 4.82 ± 2.04 per person. Nine patients (53%) required re-injection of the anti-VEGF agent; the mean number of re-injections in this group was 3.44 ± 1.34 per person (range 2-6). No significant adverse events were recorded during the study period. CONCLUSIONS Intravitreal ranibizumab is an effective and safe treatment for CNV secondary to pathologic myopia, contributing to long-term vision improvement and CFT reduction.
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FIVE-YEAR OUTCOMES OF INTRAVITREAL RANIBIZUMAB FOR CHOROIDAL NEOVASCULARIZATION IN PATIENTS WITH PATHOLOGIC MYOPIA. Retina 2019; 39:1289-1298. [DOI: 10.1097/iae.0000000000002164] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Thorell MR, Goldhardt R. Myopic Choroidal Neovascularization: Diagnosis and Treatment Update. CURRENT OPHTHALMOLOGY REPORTS 2019. [DOI: 10.1007/s40135-019-00200-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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