Comparison of structural and functional outcome of aflibercept versus ranibizumab in patients with myopic choroidal neovascularization

Treatment of myopic choroidal neovascularization: a network meta-analysis and review

PURPOSE

This is, to our knowledge, the first network meta-analysis aiming to compare all treatment modalities for myopic choroidal neovascularization (CNV).

METHODS

After the electronic databases were searched, two independent reviewers screened titles, abstracts, full-texts, and extracted information. Primary endpoints were change in visual outcome and central retinal thickness. We used a network meta-analysis to compare treatment outcomes in the early (≤ 6 months) and late (> 6 months) phase.

RESULTS

We included 34 studies (2,098 eyes) in our network meta-analysis. In the early phase, the use of anti-VEGF led to a gain of 14.1 letters (95% CI, 10.8-17.4) compared to untreated patients (p < 0.0001), 12.1 letters (95% CI, 8.3-15.8) to photodynamic therapy (PDT) (p < 0.0001), 7.5 (95% CI, 1.2-13.8) letters to intravitreal triamcinolone acetonide (TCA) (p = 0.019), and - 2.9 letters (95% CI, - 6.0-0.2) to the combination of anti-VEGF and PDT (p = 0.065). In the later phase, these results were largely maintained. There were no significant differences in visual outcomes between patients treated with 1 + PRN and 3 + PRN. However, the 1 + PRN group received 1.8 (SD 1.3), while the 3 + PRN group received 3.2 (SD 0.9) injections within 12 months (p < 0.0001).

CONCLUSION

This network meta-analysis confirms that anti-VEGF is the most effective treatment for myopic CNV using the 1 + PRN treatment strategy.

High‑dose aflibercept injection has striking effects on myopic choroidal neovascularization

The aim of the present study was to evaluate the 1-year outcomes of a high-dose aflibercept injection [4 mg 2+ pro re nata (PRN) scheme] for individuals with myopic choroidal neovascularization (mCNV) through optical coherence tomography (OCT) follow-ups. A total of 16 consecutive patients (7 males and 9 females; sixteen eyes) with mCNV were enrolled in this retrospective study. The mean age was 30.5±3.35 years and mean spherical equivalent was -7.31±0.90 D. Subjects received 4 mg aflibercept intravitreal injection on the day of diagnosis and 35 days later. Further injections of aflibercept were required when the following were detected by OCT and fluorescein angiography: i) Decrease in best corrected visual acuity (BCVA); ii) aggravation of metamorphopsia; iii) macular oedema; iv) macular haemorrhage; v) increase in retinal thickness; and vi) leakage. Ophthalmic examination and OCT were performed at the baseline, as well as at 1, 2, 4, 6, 8, 10 and 12 months after the initial aflibercept injection. BCVA and central retinal thickness (CRT) were evaluated at each follow-up. The results showed that the vision of all subjects improved following the aflibercept intravitreal injection. The mean BCVA improved from 0.35±0.15 logarithm of the minimal angle of resolution (logMAR) at the baseline to 0.12±0.05 logMAR at final follow-up (P<0.05). A reduction in metamorphopsia was observed and the mean CRT was reduced from 345.38±34.69 µm of pre-treatment levels to 222.75±8.98 µm at the last postoperative visit (P<0.05). The mean number of injections in the present study was 2.13±0.5. Out of all patients, 13 received two injections and 3 subjects received three injections. The mean follow-up was 13.41±1.17 months. Based on the outcomes, it was found that an intravitreal injection of high-dose aflibercept (4 mg 2+PRN scheme) is effective for vision improvement and stabilization. In addition, it also significantly alleviated metamorphopsia and reduced the CRT in patients treated with mCNV. During the follow-up, the eyesight of the patients was stable.

Optical coherence tomography biomarkers for myopic choroidal neovascularization treated with anti-vascular endothelial growth factor

In recent years, optical coherence tomography (OCT) biomarkers for specific retinal diseases have been found to be associated with treatment outcome and disease recurrence. The main purposes of this study were to identify OCT biomarkers for myopic choroidal neovascularization (mCNV) treated with intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF). OCT features in 43 eyes of 39 patients with mCNV treated with anti-VEGF with at least 1 year of follow-up were retrospectively analyzed. Eyes with subretinal hyperreflective material (SHM) in baseline spectral-domain OCT (SD-OCT) had significantly more visual improvement than eyes without SHM at month 6 (p = 0.007) and had a trend of more visual improvement than eyes without SHM (p = 0.058) at month 12. Eyes with subretinal fluid (SRF) at baseline had significantly more central retinal thickness (CRT) decrease than patients without SRF at month 6 and 12 (p = 0.012 and 0.006 respectively). In univariate regression analysis, dome-shaped macula (DSM), SRF in baseline OCT image and fuzzy border of mCNV when entering pro re nata (PRN) injection protocol tended to have higher risk of disease recurrence in 1 year (odds ratio: 14.86 (p = 0.003), 3.75 (p = 0.049) and 22.92 (p < 0.001) respectively). However, they were not significant in multivariate regression analysis. OCT biomarkers at baseline could provide prognostic information for mCNV management.

Alteration of plasma von Willebrand factor in the treatment of retinal vein occlusion with cystoid macular edema

Retinal vein occlusion (RVO) is a major retinal disease caused by venous thrombosis. Although several studies have proposed an association between venous thrombosis and von Willebrand factor (VWF), the association between RVO and VWF remains unclear. We aimed to investigate the association between RVO and VWF and the alteration of VWF levels under anti-vascular endothelial growth factor (VEGF) treatment. We enrolled 55 patients with RVO involved cystoid macular edema. They received intravitreal injection of anti-VEGF drugs, either ranibizumab or aflibercept. We examined the clinical data and measured plasma VWF antigen and a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13) activity to identify variabilities during treatment. At baseline, there was no significant difference between the RVO group and age-matched controls in both VWF antigen and ADAMTS13 activity levels, but ADAMTS13 activity was significantly lower in central RVO than in branch RVO (P = 0.015). In branch RVO, VWF antigen was negatively correlated with central choroidal thickness (r = −0.51, P < 0.001). In branch RVO after anti-VEGF treatment, VWF antigen levels decreased significantly from 134% at baseline to 109% at 1 day (P = 0.002) and 107% at 1 month (P = 0.030) after treatment. In contrast, ADAMTS13 activity showed no significant difference during this period. In branch RVO at 1 month after treatment, VWF antigen was negatively correlated with central choroidal thickness (r = −0.47, P = 0.001). Our findings suggest an association between VWF and central choroidal thickness in patients with branch RVO, thus the measurement of VWF may be useful for evaluating disease activity and prognosis.