Purpose
To report long-term results from intravitreal bevacizumab (IVB) treatment of choroidal neovascularization (CNV) secondary to pathological myopia (PM).
Methods
A retrospective review of eyes affected by CNV due to PM and treated with IVB (1 mg/0.04 ml) was conducted. Indication for treatment was an angiographically active lesion with/without intra- or sub-retinal fluid accumulation on spectral domain optical coherence tomography (SD-OCT). Patients received an injection at baseline and were then followed-up for a period of 60 months. Patients were scheduled for follow-up examinations at 1, 3 and 6 months after each treatment. Extra visits were planned upon patient request due to symptoms. Best-corrected visual acuity (BCVA, LogMAR), fluorescein angiography (FA) and SD-OCT were performed at baseline and at follow-up visits. Re-treatment was considered at investigator discretion at every follow-up visit. The primary efficacy outcome was change in BCVA. Secondary outcomes include the reduction in central retinal thickness (CRT) and the number of injections required during the follow-up. The incidence of ocular and non-ocular adverse events was recorded.
Results
The study included 101 consecutive eyes of 86 patients with CNV secondary to PM. Data from a 24-month follow-up are available for all patients. Thirty-two eyes reached 60 months of follow up. CNVs were located subfoveally in all eyes. Thirty-five percent of patients had received photodynamic therapy before enrollment. Mean BCVA improvement at 24 months was 0.13 (95%CI: 0.05; 0.2) logMAR (p<0.001). Retinal thickness decreased on average by 67 (95%CI: 27; 102) µm after 2 years of follow-up (p<0.01). On average, patients received 4.1 treatments in 24 months. Visual acuity improved on average by 0.05 (95%CI: -0.1; 0.2) logMAR (p>0.05) at 60 months. Mean reduction in CRT was 102 (95%CI: 64;141) µm after 5 years of follow-up (p<0.01). Patients received a mean of 6.7 treatments in 60 months. No significant adverse events were recorded during the follow up.
Conclusions
Intravitreal VEGF inhibition is an effective therapy for the treatment of myopic CNV. A pro-re-nata regimen with intravitreal bevacizumab has produced functional and morphological improvements in the mid and long-term period.
Keywords: 605 myopia •
453 choroid: neovascularization •
748 vascular endothelial growth factor