Photodynamic therapy in non-subfoveal choroidal neovascularization secondary to pathological myopia: 1-year outcome

Intravitreal bevacizumab for extrafoveal choroidal neovascularization secondary to pathologic myopia

PURPOSE

To assess the effects of intravitreal bevacizumab injections in the treatment of extrafoveal choroidal neovascularization (CNV) associated with pathologic myopia.

METHODS

Patients diagnosed with pathologic myopia complicated by extrafoveal CNV were considered in this prospective, open-label interventional study. All patients underwent a complete ophthalmologic examination, including Early Treatment Early of Diabetic Retinopathy Study (ETDRS) visual acuity measurement, optical coherence tomography, and fluorescein angiography. The protocol treatment included a first injection, followed by repeated injections over a 24-month follow-up period on the basis of optical coherence tomography and angiographic features, monitored monthly. Primary outcomes were the mean changes in best-corrected visual acuity and the proportion of eyes gaining at least 15 letters at the 24-month examination. Secondary outcomes included central macular thickness, size of the CNV, and extension to the fovea.

RESULTS

Fifteen patients were included in the study. Mean best-corrected visual acuity changed from 0.47 logarithm of the minimum angle of resolution (20/60 Snellen equivalent) at baseline to 0.22 logarithm of the minimum angle of resolution (20/30 Snellen equivalent) at the 24-month examination. An improvement of at least 3 ETDRS lines was achieved by 7 eyes (46.6%) at the 24-month examination. Mean central macular thickness changed from 313 μm to 254 μm at the 24-month examination (P = 0.008). Mean CNV size decreased from 348 μm2 to 251 μm2 at 24 months (P = 0.029).

CONCLUSION

Intravitreal bevacizumab injection is a beneficial treatment for extrafoveal CNV associated with pathologic myopia.

Choroidal neovascularization in pathological myopia

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

Hemorrhagic complications of optic disc drusen and available treatment options

BACKGROUND

Optic disc drusen typically are considered benign findings. However, optic disc drusen can manifest with hemorrhagic complications.

CASE REPORT

A dilated fundus examination on a 27-year-old visually asymptomatic optometry student found a juxtapapillary hemorrhage one quarter of a disc diameter in size in the right eye, immediately off the superior nasal aspect of the disc. Bilateral disc drusen, confirmed by hyperreflectivity on ultrasonography, were also noted. Fluorescein angiography and optical coherence tomography were diagnostic only for a deep isolated intra- and subretinal hemorrhage. Neither diagnostic modality could confirm the presence or absence of a choroidal neovascular membrane. Because of the asymptomatic nature, location of the hemorrhage, and lack of conclusive etiology, close monitoring was recommended. After 4 months, 75% of the hemorrhage had reabsorbed with no visual complications.

CONCLUSIONS

Optic disc drusen can cause ocular hemorrhages through several mechanisms. Although many are benign and self-limiting, it is important to understand available treatment modalities should vision be threatened.