Abstract
Purpose :
Evaluation of the long-term efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in the primary treatment of choroidal neovascularisation (CNV) secondary to pathological myopia.
Methods :
We performed a retrospective analysis of electronic medical records of treatment naive patients with myopic CNV who received treatment with either intravitreal ranibizumab or aflibercept (n = 37 eyes) over a 10.5 year period from September 2007 to May 2018.
Patients with prior treatment for CNV including photodynamic therapy, laser photocoagulation, or other causes of CNV such as AMD, trauma, or angioid streaks were excluded.
Patient age, gender, degree of myopia, lens status, best corrected visual acuity (BCVA) and central retinal thickness (CRT) before and after treatment, and number of injections administered was recorded.
Results :
The data set included 37 eyes of 35 patients (25 females, 12 males). The mean age was 60 years (range 26 - 89 years). 25/35 (71%) patients were aged > 50 years, 12/35 (34%) were < 50 years. 28/37 (76%) eyes were phakic and 9/37 (24%) eyes were pseudophakic. 2 patients received bilateral treatment for myopic CNV. Mean spherical equivalent was -5.81 dioptres.
26/37 (70%) eyes commenced primary treatment with ranibizumab and 11/37 (30%) eyes commenced treatment with aflibercept. Mean number of injections was 4.47 over a mean follow up period of 13.43 months.
Mean CRT decreased by 92.9μm, mean BCVA improvement was 3.91 letters. Univariate linear regression with BCVA as the outcome showed younger age (p =0.02) and fewer injections (p =0.01) were associated with final BCVA.
Baseline VA (p =0.13), and spherical equivalent (p =0.23) were not associated with final BCVA. Multiple regression showed age and fewer injections (p = 0.005) were associated with final BCVA.
Conclusions :
Myopic CNV requires less frequent anti-VEGF intravitreal therapy over a shorter follow up period than both neovascular age related macular degeneration and diabetic macular oedema. Increased frequency of administration of intravitreal anti-VEGF treatment did not improve vision. Younger age is associated with a better final visual outcome. This may be due to the effects of macular atrophy in the older age group.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.