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M. El Maftouhi-Quaranta, M. Mauget-Faÿsse; Anti-VEGF Intravitreal Injections for Myopic Choroidal Neovascularization. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5584.
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To evaluate the clinical results of anti-VEGF intra-vitreal injections (IVT) in CNV secondary to pathologic myopia (PM-CNV).
Nineteen consecutive patients (19 eyes) with subfoveal PM-CNV, 18 of whom had been unsuccessfully treated with Visudyne PDT, were treated with IVT of 1.25 mg bevacizumab or 0.5mg ranibizumab. ETDRS best corrected visual acuity, macular thickness on OCT scans, and angiographic features were recorded and evaluated. The aspect of OCT scans passing across the PM-CNV was also analyzed. IVTs were repeated only in case of persistent angiographic leakage and if OCT scans showed retinal thickening or edema and serous retinal detachment. The follow-up period was at least 6 months.
The mean age of the study patients was 62 years (32-82) and the mean refractive error -12.5 D. The mean follow-up period was 8.5 months (6 to 18). Ten eyes received bevacizumab, 6 ranibizumab, and 3 eyes initially bevacizumab and then ranibizumab. In 4 eyes, concomitant PDT treatment was performed due to a persistent perfusion of the PM-CNV after IVTs alone.In 16 eyes, a mean of 3.7 IVTs (range 1 to 13) was needed to block the PM-CNV. In the other 3 eyes, IVT therapy was discontinued due to the appearance of cystoid macular edema or serous retinal detachment on OCT scans and the proliferation of PM-CNV on FA. At 6 months post-treatment, mean VA increased from 20/80 (20/400 -20/32) to 20/63 (20/400-20/20). Only 1 patient lost 35 letters due to macular atrophy; the other 18 increased or stabilized their VA. Mean macular thickness decreased from 329 to 258 µm. No ocular or general side effects were recorded.
These short-term results suggest that anti-angiogenic IVTs are effective and safe in patients with PM-CNV. The worsening of the exudative signs on OCT and FA should be considered as a failure of anti-VEGF therapy and lead to its discontinuation. We recommend a larger, longer term, and controlled evaluation of anti-VEGF therapy in PM-CNV patients to confirm our observations.
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