Five-year outcomes of ranibizumab for myopic choroidal neovascular membrane stratified by age of onset

Abstract

Purpose : Myopic choroidal neovascularisation (CNV) can occur in any adult with high myopia. Intravitreal ranibizumab is an effective treatment for this condition but little is known whether age of onset influences long-term outcomes. Our aim was to assess the five-year outcomes of ranibizumab therapy for myopic CNV, both overall and stratified by age-groups.

Methods : We retrospectively reviewed the outcomes of consecutive patients with treatment naïve myopic CNV initiated on intravitreal ranibizumab injections between January 2014 to December 2017 at Moorfields Eye Hospital with a minimum 5-year follow up period. Primary outcomes were visual outcomes at 5 years and recurrence of active CNV. Included patients were stratified by age of onset of CNV into those younger than 50 years versus those 50 years or older.

Results : A total of 227 eyes from 220 patients were analysed. The mean age of the study cohort at first ranibizumab injection was 54.9 (±16.3) years. There were 81 patients aged 16-49 years and 139 aged between 50-91 years. Mean change in visual acuity (VA) from baseline to 1, 2, 3, 4 and 5 years was 11.5, 8.0, 6.4, 4.8 and 2.2 ETDRS letters respectively, with 58% maintaining VA of 6/12 or better at final follow-up. Recurrence occurred in 47% of the eyes at an average interval of 19.2 months (95% CI [15.3, 23.2]) from last injection. Mean number of injections was 6.4 (±8.0) injections over a 5-year period. When outcomes were analysed based on age of onset of myopic CNV, gain in VA was significantly higher (+10.6 letters) in those aged <50 years compared to those 50 years or over (+0.5 letters) (p<0.001). Moreover, three times more people aged ≥50 years had a final visual acuity of Snellen <20/200 (15% vs 5%). Baseline VA was similar between groups (<50 years mean VA of 58.9 (±19.4), ≥50 years 57.9 (±20.63). Those ≥50 years were also more likely to experience a recurrence of myopic CNV (p=0.002) and require a greater number of injections (7.9 (± 9.6) vs 4.0(±3.0), p<0.001).

Conclusions : Age of onset of myopic CNV is an important determinant of final visual outcome. Individuals aged 50 years or above are more likely to have poorer visual outcome, higher incidence of recurrence and require more injections. Appropriate counselling of expected outcomes based on age of onset is strongly recommended.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.