Long-term visual acuity after argon green laser photocoagulation of juxtafoveal choroidal neovascularization in highly myopic eyes

Long-term outcomes of anti-vascular endothelial growth factor therapy with and without posterior scleral reinforcement on myopic maculopathy in myopic choroidal neovascularization eyes

BACKGROUND

Anti-vascular endothelial growth factor (anti-VEGF) therapy is used for myopic choroidal neovascularization (mCNV). Patchy chorioretinal atrophy (pCRA) enlargement has been reported in mCNV cases associated with vision loss. Our aim was to compare the long-term effectiveness of anti-VEGF therapy alone versus anti-VEGF followed by posterior scleral reinforcement (PSR) in controlling myopic maculopathy in mCNV eyes.

METHODS

We performed a retrospective review of the medical records of 95 high myopia patients (refractive error ≥ 6.00 diopters, axial length ≥ 26.0 mm) with mCNV. Patients were treated with anti-VEGF alone (group A) or anti-VEGF followed by PSR (group B). The following data were collected: refractive error, best corrected visual acuity (BCVA), ophthalmic fundus examination, ocular coherence tomography and ocular biometry at 12 and 24 months pre- and postoperatively. The primary outcomes were changes in pCRA and BCVA.

RESULTS

In 26 eyes of 24 patients, the mean pCRA size significantly increased from baseline (0.88 ± 1.69 mm2) to 12 months (1.57 ± 2.32 mm2, t = 3.249, P = 0.003) and 24 months (2.17 ± 2.79 mm2, t = 3.965, P = 0.001) postoperatively. The increase in perilesional pCRA in group B (n = 12) was 98.2% and 94.2% smaller than that in group A (n = 14) at 12 and 24 months (Beta 0.57 [95% CI 0.01, 191 1.13], P = 0.048). In group B, 7 eyes (58.3%) gained more than 2 lines of BCVA compared with only 4 eyes (28.6%) in group A at 24 months.

CONCLUSION

Anti-VEGF therapy followed by PSR achieved better outcomes than anti-VEGF therapy alone in controlling the development of myopic maculopathy in mCNV and may constitute a better treatment option by securing a better long-term VA outcome.

Genetic Polymorphisms in VEGFR Coding Genes (FLT1/KDR) on Ranibizumab Response in High Myopia and Choroidal Neovascularization Patients

A severe form of myopia defined as pathologic/high myopia is the main cause of visual impairment and one of the most frequent causes of blindness worldwide. It is characterized by at least 6 diopters or axial length (AL) of eyeball > 26 mm and choroidal neovascularization (CNV) in 5 to 10% of cases. Ranibizumab is a humanized recombinant monoclonal antibody fragment targeted against human vascular endothelial growth factor A (VEGF-A) used in the treatment of CNV. It acts by preventing VEGF-A from interacting with its receptors (VEGFR-1 and -2) encoded by the FLT1 and KDR genes. Several studies found that the KDR and FLT1 genotypes may represent predictive determinants of efficacy in ranibizumab-treated neovascular age-related macular degeneration (nAMD) patients. We performed a retrospective study to evaluate the association of single nucleotide polymorphisms (SNPs) in VEGFR coding genes with the response rate to ranibizumab in patients with high myopia and CNV. In the association study of genotypes in FLT1 with the response to ranibizumab, we found a significant association between two FLT1 variants (rs9582036, rs7993418) with ranibizumab efficacy at the 12-month follow-up. About the KDR gene, we found that two KDR variants (rs2305948, rs2071559) are associated with best-corrected visual acuity (BCVA) improvement and KDR (rs2239702) is associated with lower rates of BCVA worsening considering a 12-month follow-up period.

A systematic review of clinical practice guidelines for myopic macular degeneration

Background

Methods

Results

Conclusions

Genetic Polymorphisms Affecting Ranibizumab Response in High Myopia Patients

High myopia is an ophthalmic pathology that affects half of the young adults in the United States and Europe and it is predicted that a third of the world’s population could be nearsighted at the end of this decade. It is characterized by at least 6 diopters or axial length > 26 mm and, choroidal neovascularization (CNV) in 5 to 11% of cases. Ranibizumab is a recombinant humanized monoclonal antibody fragment. It is an anti-vascular endothelial growth factor (anti-VEGF) drug used in the treatment of CNV. Many genetic polymorphisms have been associated with interindividual differences in the response to ranibizumab, but these associations were not yet assessed among patients with high myopia and CNV. We performed a retrospective study assessing the association of genetic polymorphisms with response to ranibizumab in patients with CNV secondary to high myopia (mCNV). We included genetic polymorphisms previously associated with the response to drugs used in CNV patients (bevacizumab, ranibizumab, aflibercept, and photodynamic therapy (PDT)). We also included genetic variants in the VEGFA gene. Based on our results, ARMS2 (rs10490924) and CFH (rs1061170) are associated with response to ranibizumab in high myopia patients; and, included VEGFA genetic polymorphisms are not associated with ranibizumab response in our population but might be related to a higher risk of CNV.

Pilot study of ziv-aflibercept in myopic choroidal neovascularisation patients

Background

Myopic choroidal neovascularization (CNV) is the most common sight-threatening complication associated with high myopia. The present study evaluated the efficacy and safety of the intravitreal injection of ziv-aflibercept in patients with myopic CNV.

Methods

This prospective interventional study was conducted on 20 eyes of 20 patients with active myopic CNV. Twelve patients were 40 years or older. This study was performed in the Ophthalmology Department of Tanta University Eye Hospital, Tanta University, Egypt. Optical coherence tomography (OCT) was performed for all patients at baseline and monthly after injection during the 6-month follow up period. The main outcome measures were changes in BCVA and CMT. The exploratory outcome measures were CNV size, IOP and the number of injections needed in each age group during the study period.

Results

Patients with myopic CNV younger than 40 years needed fewer injections (2.00 ± 0.76) than patients older than 40 years (2.50 ± 1.00), with no statistical significance detected between the two groups (p-value 0.246). CNV was smaller in the younger age group (p-value 0.209), best corrected visual acuity (BCVA) improved significantly in the younger and older age groups (p-values 0.001 and 0.028, respectively), and central macular thickness (CMT) decreased significantly after 6 months, from 242.88 ± 23.83 μm to 191.13 ± 13.83 μm in the younger age group and from 251.33 ± 26.60 μm to 197.08 ± 17.64 μm in the older age group (p = 0.001). No significant correlation was found between the final BCVA and either the spherical equivalent or central macular thickness after 6 months, with p-values of 0.135 and 0.145, respectively. No significant changes in IOP were detected in either group after the intravitreal injection.

Conclusion

Ziv-aflibercept is a highly effective and safe drug in cases of active myopic CNV; however, a larger number of patients and a longer follow-up period are needed to confirm our results.

This study was retrospectively registered at clinicaltrials.gov (ID: NCT04290195) on 26-2-2020.

Anti-vascular endothelial growth factor therapy for the treatment of myopic choroidal neovascularization

Myopic choroidal neovascularization (CNV) is a sight-threatening condition which occurs in eyes with myopia, particularly in those with pathologic myopia. It is the most common cause of CNV among patients younger than 50 years. Hemorrhage and exudation from the CNV lesion may eventually result in scarring or chorioretinal atrophy. While myopic CNV was previously treated with focal laser photocoagulation or photodynamic therapy (PDT), the current treatment of choice is anti-vascular endothelial growth factor (VEGF) agents. Many studies have demonstrated the efficacy of intravitreal anti-VEGF agents in the treatment of myopic CNV. The RADIANCE study reported that intravitreal ranibizumab was superior to PDT in eyes with myopic CNV (at 3 months, both groups receiving intravitreal ranibizumab gained 10.5 and 10.6 letters vs 2.2 letters among patients receiving PDT). In addition, the study demonstrated similar visual outcomes in eyes treated on the basis of visual acuity stabilization or disease activity criteria. Other clinical studies have provided evidence for the efficacy of ranibizumab and aflibercept in the treatment of myopic CNV. This review addresses the epidemiology, pathophysiology, and imaging characteristics of myopic CNV, and discusses the evidence for the efficacy of anti-VEGF agents as compared to laser photocoagulation and PDT.

The role of anti-VEGF agents in myopic choroidal neovascularization: Current standards and future outlook

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.

Clinical characteristics and antivascular endothelial growth factor effect of choroidal neovascularization in younger patients in Taiwan

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.

Myopic choroidal neovascularisation: current concepts and update on clinical management

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.

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

Choroidal neovascularization (CNV) secondary to pathological myopia is an important cause of significant visual impairment in young adults. High myopia is particularly prevalent in Asian population. New scientific contributions have been made to the understanding of high myopia and myopic CNV. Treatment for myopic CNV has previously relied on photodynamic therapy, laser photocoagulation, and submacular surgery. The treatment outcomes from these modalities are, however, controversial. The introduction of antiangiogenic agents including bevacizumab and ranibizumab has brought the treatment of myopic CNV into a new era. The purpose of this review was to provide an overview of the natural history of myopic CNV, the prognostic factors, and the various treatment options including laser photocoagulation and photodynamic therapy, with particular attention on antiangiogenic agents.

Anti-vascular endothelial growth factor for myopic choroidal neovascularization

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Long-term pattern of progression of myopic maculopathy: a natural history study

OBJECTIVE

To investigate the long-term progression pattern of myopic maculopathy and to determine the visual prognosis of each progression stage.

DESIGN

Retrospective, observational case series.

PARTICIPANTS

The medical records of 806 eyes of 429 consecutive patients with high myopia (refractive error more than -8.00 diopters [D] or axial length > or =26.5 mm) who were followed for 5-32 years were reviewed.

METHODS

Participants had complete ophthalmological examinations including best-corrected visual acuity, axial length measurements, fluorescein angiography, and color fundus photography, at least once a year. The presence and type of posterior staphyloma was determined by binocular stereoscopic ophthalmoscopy. The types of myopic maculopathy included tessellated fundus, lacquer cracks, diffuse chorioretinal atrophy, patchy chorioretinal atrophy, choroidal neovascularization (CNV), and macular atrophy. None of the patients had received any type of treatment for the maculopathy.

MAIN OUTCOME MEASURES

The longitudinal long-term progression pattern and the visual prognosis of each type of fundus lesion.

RESULTS

During the mean follow-up of 12.7 years, 327 of the 806 highly myopic eyes (40.6%) showed a progression of the myopic maculopathy. The most commonly observed patterns were from tessellated fundus to the development of diffuse atrophy and lacquer cracks, an increase in the width and progression to patchy atrophy in eyes with lacquer cracks, an enlargement of the diffuse atrophy, and the development of patchy atrophy in eyes with diffuse atrophy, and an enlargement and fusion of patches of atrophic areas in eyes with patchy atrophy. Eyes with tessellated fundus, lacquer cracks, diffuse atrophy and patchy atrophy at the initial examination progressed to the development of CNV. Eyes with CNV developed macular atrophy. The fusion of patchy atrophy, the development of CNV, and macular atrophy all led to significant visual decreases. A posterior staphyloma was observed more frequently in eyes that showed progression from tessellated fundus, diffuse atrophy, and patchy atrophy than those without a progression.

CONCLUSIONS

These findings indicate that myopic maculopathy tends to progress in approximately 40% of highly myopic eyes, and the pattern of progression affects the visual prognosis. Preventive therapy targeting posterior staphyloma should be considered to prevent the visual impairment caused by the progression of myopic maculopathy.

Bevacizumab (Avastin) for the treatment of ocular disease

The use of intravitreal bevacizumab (Avastin) has greatly expanded since its introduction into ophthalmic care 3 years ago. A PubMed search on 1 August 2008 revealed 51 ocular disease processes that have been treated with bevacizumab. The majority of publications consist of case reports or retrospective case series and their number is increasing quickly. It is important to collate the experiences gained to date to properly inform our clinical decision making and improve the design of future clinical trials. Current studies cannot easily be combined in a meta-analysis given the lack of standardized data and the wide variety of disorders studied in small numbers. This paper will describe the attempted uses of intravitreal bevacizumab and its efficacy for each ocular disease in addition to discussing safety. Comments regarding appropriate use of this treatment are based on our current level of knowledge. It is clear that the initial encouraging results described in this paper warrant further study of intravitreal bevacizumab in larger, controlled, randomized trials.

Two years follow-up outcome of verteporfin therapy for subfoveal choroidal neovascularization in pathologic myopia in Indian eyes

CONTEXT

In India, refractive errors are a major cause of treatable blindness. Population surveys in southern India have shown prevalence of high myopia to be 4.32-4.54%. Photodynamic therapy (PDT) for choroidal neovascularization (CNV) caused by pathologic myopia is beneficial.

AIMS

To report the 24 months outcome of PDT with verteporfin for subfoveal CNV caused by pathologic myopia in Indian eyes.

SETTINGS AND DESIGN

Prospective case series.

MATERIALS AND METHODS

Review of prospectively collected data of Indian patients with pathologic myopia and subfoveal CNV treated with verteporfin therapy between 2001 and 2005 using standard regimen for PDT.

STATISTICAL ANALYSIS USED

Wilcoxon signed rank test was used to see the difference in the mean letter acuity at intervals compared to baseline. Kaplan Meier Survival analysis was done to estimate the success rate of verteporfin therapy for CNV caused by pathologic myopia.

RESULTS

Fifteen patients (15 eyes) treated with standard fluence PDT and who had completed 24 months follow-up were analyzed. The mean spherical equivalent was -13.36 +/- 5.88 diopter. Five out of 15 eyes in six months, three out of 15 eyes at 12 months and four eyes out of 15 at 24 months had improved vision by > 10 letters. The mean number of treatment session was 2.2 in two years.

CONCLUSIONS

PDT with verteporfin for subfoveal CNV caused by pathologic myopia in Indian eyes is effective.

Photodynamic therapy with verteporfin for juxtafoveal choroidal neovascularization in pathologic myopia: a long-term follow-up study

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.

Combined photodynamic therapy and intravitreal triamcinolone injection for the treatment of choroidal neovascularisation secondary to pathological myopia: a pilot study

Intravitreous triamcinolone associated with PDT should preferably be used among elderly patients who usually show lower visual acuity and a poorer response to PDT, or among patients with recurrent or greater CNVs

Transpupillary thermotherapy for myopic choroidal neovascularization: 1-year follow-up

PURPOSE

To evaluate the use of transpupillary thermotherapy (TTT) for myopic choroidal neovascularization (CNV) retrospectively in a case series.

METHODS

Ten consecutive patients with CNV secondary to high myopia were treated with TTT and followed-up for 18.3 +/- 7.1 months (range: 12-30 months). An activity scoring (AS) scheme based on CNV size, central foveal thickness as determined by optical coherence tomography (OCT), amount of subretinal hemorrhage, and fluorescein angiography (FA) staining characteristics was developed to assess the response to treatment. The main outcome measures were AS and visual acuity (VA).

RESULTS

There was no significant loss or gain in VA, and the lesions stabilized in all eyes. FA revealed late staining typical of CNV scarring, and the amount of central foveal thickness decreased in all eyes, as determined by OCT. The mean AS at 3, 6, and 12 months and at the final visit were significantly lower than the preoperative AS (P<0.05). No complication occurred during or after treatment.

CONCLUSION

A scheme for evaluating overall CNV activity may be useful tool for assessing the response of patients to TTT. TTT seems to stabilize myopic CNVs both clinically and as revealed by angiography, with a significant decrease in the activity of lesions. Longer term results are required to evaluate the stabilizing effect of TTT in myopic CNV.

Photodynamic Therapy in Macular Diseases of Asian Populations: When East Meets West

PURPOSE

We reviewed the indications, safety, and efficacy of photodynamic therapy with verteporfin in various macular diseases and vasculopathies, which are common in Asian populations, and compared the outcomes of photodynamic therapy in Asian patients with the outcomes in Caucasian patients.

METHODS

Relevant clinical and laboratory original articles, case reports, and review articles that have been published in the literature between January 1999 and October 2004 were searched in Medline. The potential differences in the response to photodynamic therapy between Asian and Caucasian patients were evaluated. Articles in foreign languages with English abstracts were included.

RESULTS

Macular diseases commonly seen in Asian populations, including choroidal neovascularization (CNV) of age-related macular degeneration, secondary to pathologic myopia or from an idiopathic cause, and choroidal vasculopathies such as central serous chorioretinopathy and polypoidal choroidal vasculopathy were included in the review. The results were tabulated and the differences with Caucasian populations were compared and highlighted.

CONCLUSION

Photodynamic therapy has been found to be an effective and noninvasive treatment for various subfoveal CNV and choroidal vasculopathies of the macula. Diverse behavior in different ethnic groups is observed.

Photodynamic therapy with verteporfin for juxtafoveal choroidal neovascularization secondary to pathologic myopia-1-year results of a prospective series

PURPOSE

To study the efficacy of photodynamic therapy (PDT) with verteporfin in the treatment of juxtafoveal choroidal neovascularization (CNV) secondary to pathologic myopia.

METHODS

Prospective, open label, two-centre, noncomparative, interventional case series. Consecutive patients with juxtafoveal CNV associated with pathologic myopia were recruited and treated with a standard regimen of PDT with verteporfin. Patients were being followed up every 3-monthly and retreatment was considered when there was evidence of angiographic leakage. Outcome measures included changes in the mean best-corrected visual acuity (BCVA) at the 1-year follow-up when compared with the baseline, the proportion of patients who had stable (within 1 line) and improved visions.

RESULTS

A total of 11 eyes from 11 patients with juxtafoveal CNV secondary to pathologic myopia were recruited and all completed the 1-year follow-up. The mean age at presentation was 44.8 years. The refractive error ranged from -6.0 to -15.0 D (+/-SD was -9.55+/-3.04 D). The logMAR BCVA improved from 0.57 to 0.39 at the 1-year follow-up (Wilcoxon signed-ranks test, P=0.027). The mean improvement was 1.8 lines. Five eyes (45.4%) had BCVA improved by >or=3 lines. None of the treated patients had visual loss of >or=1 line. The mean number of treatments over the 12-month study period was 2.3 sessions.

CONCLUSIONS

The results are encouraging, especially on considering the low retreatment rate, stable or improved BCVA in all treated eyes, and consistently good safety profile. Juxtafoveal myopic CNV may be an expanded indication for PDT with verteporfin.

Choroidal neovascularisation in pathological myopia: an update in management

Choroidal neovascularisation (CNV) secondary to pathological myopia is an important cause of significant visual impairment in young and middle aged adults globally and is particularly prevalent in Asian populations. In the past few years, there have been rapid advancements in the different treatments for myopic CNV. The purpose of this perspective is to give an overview of the natural history of myopic CNV and the various treatment options including laser photocoagulation, photodynamic therapy, sub-macular surgery, and macular translocation surgery. Future directions in the management of myopic CNV are also discussed.

Myopic choroidal neovascularization: natural course and treatment

PURPOSE OF REVIEW

Choroidal neovascularization (CNV) is the most common vision-threatening complication of high myopia. Myopic CNV has recently attracted a lot of attention, mainly because of a variety of newly developed treatments. To evaluate the efficacy of these new treatments against myopic CNV, we need to know more precisely the natural course of myopic CNV. The results of most previously reported studies regarding the natural course of myopic CNV, however, are somewhat contradictory. In this review, we describe the recently reported long-term prognosis of myopic CNV and the effectiveness of newly developed treatments as well as an overview of possible future treatments.

RECENT FINDINGS

A recent study evaluating the visual outcome of myopic CNV for at least 10 years after onset in a large series of patients reported that the visual prognosis of myopic CNV without treatment is extremely poor, mainly because of the secondary development of chorioretinal atrophy around the area of regressed CNV. Although conventional treatments against myopic CNV, such as laser photocoagulation or surgical extraction of CNV, have not been effective, newly developed treatments such as foveal translocation or photodynamic therapy have had favorable results on myopic CNV in the short-term. Pharmacologic interventions to treat or prevent CNV are also expected in the future.

SUMMARY

Because the natural prognosis of myopic CNV is extremely poor, treatment to prevent further visual loss is necessary. Based on the steady and gradual visual decrease in myopic CNV over the long term, however, long-term results are needed before the true effectiveness of the newly developed active treatments can be determined.

Subretinal fibrosis after photodynamic therapy in subfoveal choroidal neovascularisation in highly myopic eyes

AIMS

To analyse the occurrence of subretinal fibrosis (SRF) after photodynamic therapy (PDT) with verteporfin in highly myopic eyes with subfoveal choroidal neovascularisation (CNV).

METHODS

PDT with verteporfin was performed on 33 eyes of 32 highly myopic patients with subfoveal CNV. Patients were followed for 14-24 months and best corrected visual acuity (BCVA) and angiographic and funduscopic findings were recorded.

RESULTS

Two patients (two eyes) were lost to follow up. SRF appeared in 14 of 31 eyes. SRF appeared more frequently in eyes with a spherical equivalent (SE) of less than -10 D, in patients of age equal to or less than 55 years, and when CNVs were larger than 1500 micro m in diameter. SRF appeared more frequently in the group of patients with worse final BCVA.

CONCLUSIONS

The appearance of SRF after treatment is correlated with size of the CNV and SE. The results of this study indicate that highly myopic eyes with CNV treated with PDT do not show a decrease in BCVA, even though they develop SRF. The appearance of SRF after PDT in highly myopic CNV does not always imply a loss of BCVA from baseline, though its presence is more frequent in eyes with lower BCVA.

Verteporfin photodynamic therapy in highly myopic subfoveal choroidal neovascularisation

AIMS

To analyse the visual and angiographic results of photodynamic therapy (PDT) with verteporfin in highly myopic patients with subfoveal choroidal neovascularisation (CNV).

METHODS

PDT was performed on highly myopic patients with subfoveal CNV. The patient population was divided into two groups according to age at onset of CNV (group 1 aged < or = 55 and group 2 aged >55 years old). Best corrected visual acuity (BCVA) and angiographic findings were considered.

RESULTS

At the end of follow up group 2 had worse BCVA than group 1. 76% of patients in both groups showed a complete closure of CNV at the end of follow up.

CONCLUSION

Visual prognosis of myopic CNV treated by PDT is influenced by age at onset.