FACTORS ASSOCIATED WITH VISUAL OUTCOMES AND TREATMENT BURDEN OF MYOPIC NEOVASCULARIZATION OVER 10 YEARS

Abstract

Purpose : Vascular endothelial growth factor (VEGF) inhibitors provide excellent functional and morphological benefits in treating myopic macular neovascularization (mMNV) in the short term. We longitudinally investigated the real-life visual outcomes and the treatment burden of mMNV over a decade.

Methods : Retrospective electronic record review of adult patients with myopic refraction (<-1.00 D) and active mMNV undergoing at least one anti-VEGF agents’ injection between January 2009 and March 2021. Best-corrected visual acuity (BCVA), optical coherence tomography findings, and number of intravitreal anti-VEGF injections administered were extracted at each visit. Factors associated with BCVA change were identified with linear mixed models. Treatment burden was quantified as number of injections to mMNV inactivation and rate of mMNV recurrences. Risk factors for recurrences were identified using recurring-events regression models.

Results : A total of 327 eyes (69% females; median[interquartile range, IQR] refraction -11 D [-14 to -9]) were included; 123 eyes (38%) had ≥5-year follow-up. mMNV presenting with subretinal fluid at baseline (estimate[SE]=0.84[0.40], p=0.03) required a higher number of injections for inactivation. BCVA returned to baseline at 3 years and then worsened (Figure 1). Central macular mMNV location (estimate[SE]= 0.07[0.06] vs. extrafoveal, p=0.01) had the worst prognostic effect on the visual acuity. In 174 eyes (53%), mMNV activity recurred; cumulative number of recurences was 3 at 10 years (Figure 2). Recurring eyes had a faster rate of vision loss (estimate[SE]=0.001[0.002] LogMAR/year for each recurrence, p=0.001) than non-recurring eyes. Older age (HR[95% CI]= 1.10[1.01-1.20] for each 10-year increase, p=0.04), larger mMNV (HR[95% CI]= 1.07[1.01-1.13] for each 1-mm² increase, p=0.02), and juxtafoveal mMNV (HR[95% CI]=1.61[1.04-2.51] vs. extrafoveal, p=0.03) were risk factors for recurrences.

Conclusions : mMNV patients progressively lose vision over the long term, despite intravitreal treatments. Older adults with large, central mMNV lesions have a higher risk of mMNV recurrence and faster rates of vision loss.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Loess regression curves showing the change in best-corrected visual acuity (BCVA) during the follow-up.

 

Left. Mean cumulative number of recurrences over the follow-up.
Right. Mean cumulative number of recurrences over the follow-up stratified by mMNV area and location.