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C. C. Chow, F. Y. Chau, J. I. Lim; Response of Myopic Choroidal Neovascularization to Anti-VEGF Therapy: Spectral Domain Optical Coherence Tomography Characteristics and Visual Outcomes. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2216.
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© ARVO (1962-2015); The Authors (2016-present)
Intravitreal anti-VEGF has recently become the first line therapy for myopic choroidal neovascularization (CNV). Our study was conducted to determine whether morphologic findings on high resolution spectral domain optical coherence tomography (SDOCT) prior to anti-VEGF treatment were predictive of anatomic and visual outcome in myopic CNV.
Medical records, Heidelberg spectral domain optical coherence tomography (SDOCT), and fluorescein angiograms from 11 myopic CNV patients treated with either bevacizumab or ranibizumab were retrospectively reviewed. Visual acuity, number of treatments, central subfield thickness, size of CNV, characteristics of the CNV, disruption of inner/outer segment (IS/OS) junction, extent of RPE atrophy before and after anti-VEGF treatment were analyzed.
Median follow up was 8 months (range 1 to 33 months). Median number of treatments was 2 (range 1 to 5). Post-treatment visual acuity was improved 3 or more lines in 4 of 11 (36%) eyes, improved 1-2 lines in 6/11 (55%) eyes, and unchanged in 1/11 (9%) eyes. Pre-treatment SDOCT showed the CNV as one of four patterns: Type 1 - interruption of outer nuclear layer and IS/OS junction; type 2 - a mildly hyperreflective lesion with "smudging" into the outer nuclear layer; type 3 - a highly hyperreflective lesion with hazy borders, with or without extension into the outer nuclear layer; and type 4 - highly hyperreflective lesion with well demarcated borders. Post-treatment, eyes with either type 1 or 2 responded well with resolution of the IS/OS junction and outer nuclear layer "smudging." Eyes with type 3 responded partially with resolution of the haziness along the CNV borders but no change in the hyperreflective lesion. Eyes with type 4 did not show response on SDOCT. Visual acuity outcome correlated with the location of the CNV: 1) subfoveal CNV occurred in 3 of 11 (27%) eyes with 2 eyes improving 3 or more lines and 1 eye improving 1-2 lines; 2) juxtafoveal CNV occurred in 7 of 11 (55%) eyes with 2 eyes improving 3 or more lines and 5 eyes improving 1-2 lines; and 3) extrafoveal CNV occurred in 1 of 11 (9%) eyes which remained stable.
Spectral domain optical coherence tomography demonstrated characteristic features that could help predict outcome in myopic CNV patients being treated with anti-VEGF medications. This could help with counseling patients on balancing potential risks and benefits of anti-VEGF treatment.
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