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Seong Joon Ahn, Se Joon Woo, Kyu Hyung Park; Subfoveal Fibrosis and Visual Outcome in Myopic Choroidal Neovascularization Treated with Anti-vascular Endothelial Growth Factor. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):166.
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To assess baseline and follow-up characteristics of choroidal neovascularization (CNV) lesions in eyes with myopic CNV with respect to the development of subfoveal subretinal fibrosis
In 51 eyes treated with anti-vascular endothelial growth factor (anti-VEGF) therapy in a pro re nata regimen for myopic CNV, degree of subfoveal fibrosis at baseline and follow-up examinations was determined using fundus photographs and spectral-domain optical coherence tomography (OCT) images. The 2-year incidence of development or progression of subfoveal fibrosis was calculated and the best-corrected visual acuity at the 2-year visit was compared between the eyes with and without subfoveal fibrosis. The risk factor for the development or progression of subfoveal fibrosis was identified using baseline funduscopic and OCT parameters.
Fifty-one eyes received 2.0 ± 1.3 injections for 2-year period. The subfoveal fibrosis was present in 13 (25.5%) and 28 (54.9%) eyes at baseline and the 2-year visit, respectively. The new development or progression of subfoveal fibrosis following anti-VEGF therapy was noted in 18 eyes during the 2-year period; the 2-year incidence of subfoveal fibrosis development or progression was 35.3%. Between eyes with and without subfoveal fibrosis, there were significant differences in mean BCVA at baseline (1.15 ± 0.38 in 13 eyes with fibrosis vs. 0.63 ± 0.48 in 38 eyes without fibrosis, P = 0.001) and the 2-year visit (0.69 ± 0.48 In 28 eyes vs. 0.36 ± 0.30 in 23 eyes, P = 0.010). There was significant association between the grade of subfoveal fibrosis and the 2-year BCVA (r = 0.583, P < 0.001). Although the eyes without development or progression of subfoveal fibrosis showed significant visual improvement following anti-VEGF therapy (0.70 ± 0.44 to 0.51 ± 0.44 logMAR, P = 0.002), those with fibrosis development or progression had no significant improvement (0.90 ± 0.62 to 0.81 ± 0.58 logMAR, P = 0.421). The discontinuous retinal pigment epithelium line at baseline OCT was associated with the fibrosis (P = 0.010 by logistic regression analysis).
The development of subfoveal fibrosis in myopic CNV was associated with poor visual outcome. As its development is not uncommon, it can be an important cause of visual impairment in eyes with myopic CNV following anti-VEGF therapy.
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