Abstract
Purpose :
To evaluate the short and long-term efficacy of Anti-Vascular Endothelial Growth Factor (VEGF) intravitreal therapy with a Pro Re Nata (PRN) approach in the treatment of myopic choroidal neovascularization (CNV) and to investigate the correlation of basal risk factors with treatment outcomes, in order to individualize treatment.
Methods :
Observational, retrospective study of 91 patients (28 men and 63 women) treated with Anti-VEGF therapy due to neovascularization secondary to pathologic myopia for a 1 to 6 years period. Best Corrected Visual Acuity (BCVA) and Central Retinal Thickness (CRT) before and after treatment were analyzed. The mean number of injections in the first year, and during the whole treatment period was assessed. Additionally, prognostic factors for Anti-VEGF treatment were identified such as age, baseline visual acuity, localization and anatomic features of CNV studied by OCT, as well as treatment considerations.
Results :
Mean (SD) age at onset was 67.9 (14.4) years. The BCVA (logMAR) improved from 0.72 at baseline to 0.53 one month after the first injection, it remained stable in 0.53 after three months. BCVA after 6 years was 0.58 (p< 0.05 in all cases). A reduction of 47.96µm (p< 0.05) in CRT was observed in OCT three months after treatment. The mean number of injections during the first year was 3.05, and 3.65 for the complete follow-up period. BCVA improved 3 lines in young patients, compared to 1 line in patients over 60 years (p= 0.115). One month after treatment, BCVA in subfoveal CNV changed from 0.85 to 0.66 (p< 0.05), whereas in yuxtafoveal CNV it improved from 0.58 to 0.39 (p< 0.05). Type 2 CNV demonstrated a better response to treatment (from 0.71 to 0.56) than type 1 CNV (from 0.75 to 0.62), p< 0.05.
Conclusions :
Anti-VEGF therapy has demonstrated efficacy in the short and long-term with a significant improvement in BCVA and in CRT. The PRN regimen or “as needed” is appropriate and includes a more individualized treatment approach. Advanced age, poor baseline visual acuity and subfoveal localization worsen prognosis. However, further studies are needed in order to identify which patients would benefit from a more intensive therapy in the long term.
This is a 2021 ARVO Annual Meeting abstract.