Intravitreal Ranibizumab for Myopic Choroidal Neovascularization

Abstract

Purpose: : To assess the efficacy and safety of intravitreal ranibizumab (IVR) in patients with sub or juxtafoveal choroidal neovascularization secondary to pathologic myopia (mCNV), naïve or unresponsive to prior photodynamic therapy (PDT) or intravitreal bevacizumab (IVB).

Methods: : 14 eyes of 14 patients with sub or juxtafoveal mCNV treated with IVR, were retrospectively studied. Patients were divided in two groups. In one group (group 1) patients were treated with a single IVR and in the other group (group 2) underwent to three consecutive IVR performed on a monthly basis. Thereafter the need for additional injections was based on predefined retreatment criteria: persistence or increase of fluorescein leakage, new hemorrhage, persistence or appearance of sub/intraretinal fluid on OCT. Main outcome measures were changes in best corrected visual acuity (BCVA) and angiographic lesion characteristics. Safety was tested through occurrence of treatment-related ocular or systemic complications.

Results: : The mean follow-up was 5 months (range 2-10) for group 1 (10 patients) and 10 months (range 4-12) for group 2 (4 patients). Sub-group analysis revealed that mean VA increased significantly from week 8 to 12 in group 1 and from week 1 to the end of follow up in group 2. In both groups we had a decrease of CNV greatest linear dimension (GLD) but it never becomes statistically significant. In the end of follow-up 4 of the 10 patients of group 1 showed a persistence of CNV, after a mean number of 2 IVR (range 1-4), in contrast with group 2 where none of the 4 patients presented signs of CNV activity after a mean number of 4 IVR (range 3-4).

Conclusions: : Short-term results suggested that IVR provides significant functional and important anatomical improvement with no significant adverse events in patients with sub or juxtafoveal mCNV naïve or unresponsive to prior PDT or IVB. Despite the small sample of eyes and a limited follow-up, the effectiveness of intravitreal ranibizumab demonstrated to be encouraging. Further prospective long-term studies are necessary to evaluate safety and efficacy of intravitreal ranibizumab in the treatment of myopic CNV.

Keywords: myopia • choroid: neovascularization