June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Myopic choroidal neovascularization: a long-term follow-up of anti-VEGF treatment in a large European cohort.
Author Affiliations & Notes
  • Monica Ravenstijn
    Rotterdams Oogheelkundig Instituut, Rotterdam, Zuid Holland, Netherlands
  • Caroline C W Klaver
    Dept. of Ophthalmology / Dept. of Epidemiology, Erasmus MC, Rotterdam, Netherlands
    Dept. of Ophthalmology, Radboudumc, Nijmegen, Gelderland, Netherlands
  • Suzanne Yzer
    Dept. of Ophthalmology, Radboudumc, Nijmegen, Gelderland, Netherlands
  • Footnotes
    Commercial Relationships   Monica Ravenstijn Bayer, Code R (Recipient); Caroline Klaver Bayer; Thea Pharma, Code C (Consultant/Contractor), Thea Pharma, Code R (Recipient); Suzanne Yzer None
  • Footnotes
    Support  Oogfonds, Landelijke Stichting voor Blinden en Slechtzienden, Algemene Nederlandse Vereniging Ter Voorkoming Van Blindheid and Stichting Beheer ‘t Schild through Uitzicht (2019-14), Rotterdamse Stichting Blindenbelangen (20190034) and Stichting Wetenschappelijk Onderzoek Oogziekenhuis (2019S06).
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 3808 – F0229. doi:
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      Monica Ravenstijn, Caroline C W Klaver, Suzanne Yzer; Myopic choroidal neovascularization: a long-term follow-up of anti-VEGF treatment in a large European cohort.. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3808 – F0229.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : Intravitreal anti-vascular endothelial growth factor (VEGF) improves the visual prognosis in myopic choroidal neovascularization at short term, but visual acuity (VA), recurrence rate, and second eye involvement at long-term remain unclear. We performed a longitudinal clinical study with real-world data to learn about the long-term outcomes of anti-VEGF in a large European cohort.

Methods : Up to 12 years of longitudinal data from a tertiary hospital in the Netherlands (2008 – 2018) were analyzed. Patients with high myopia (spherical equivalent (SE) ≤-6D), an active CNV lesion, European descent and no history of anti-VEGF treatment were monitored. A total of 98 eyes (mean SE -14 ± 4D) of 87 patients (mean age 57±14 years) were included. Course of VA during follow-up, recurrence rate and second eye involvement were analyzed as outcomes. Change in VA during follow-up was compared using paired t-tests. Cox proportional hazard models tested the effect of the presence of chorioretinal atrophy (CRA) and lacquer cracks on mCNV recurrence or second eye involvement.

Results : VA significantly improved after a median of 2 anti-VEGF injections (P<0.001). At 4 years, the improvement in VA disappeared (P=0.6) and continued to deteriorate (Figure 1). The average decrease of VA was 0.05 LogMar per year. The cumulative incidence of recurrent mCNV was 52% at 5 years after the first episode. VA in eyes with recurrent mCNV decreased at a similar rate (P=0.5). Diffuse CRA (HR 10.6 95% CI 2.2-51.3, P=0.003) and patchy CRA (HR 5.2 95% CI 1.2-22.0, P =0.027) were significant predictors for mCNV recurrence. In 22 (25%) patients, the fellow eye developed mCNV after an average of 5.7 years. Age ≤ 40 years at first onset of mCNV significantly increased the risk of bilateral mCNV (HR 4.5, 95% CI 1.4–13.9, P=0.008). CRA and lacquer cracks in the fellow eye at baseline did not add significantly to the risk of mCNV in that eye.

Conclusions : This large mCNV study revealed that VA improvement after IVB injections was not maintained at long-term. Recurrences occurred frequently but did not alter the already poor visual prognosis. We advise to closely monitor patients with mCNV since recurrences occur in more than 50%, and pay particular attention to patients younger than 40 years as they are at high risk of second eye involvement.

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


VA change from baseline after anti-VEGF treatment in eyes with mCNV.

VA change from baseline after anti-VEGF treatment in eyes with mCNV.


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