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Valentina Sarao, Daniele Veritti, Sara Macor, Paolo Lanzetta; Intravitreal Bevacizumab for Choroidal Neovascularization due to Pathological Myopia: Long-term Outcomes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2796.
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To report long-term results from intravitreal bevacizumab (IVB) treatment of choroidal neovascularization (CNV) secondary to pathological myopia (PM).
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.
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.
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.
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