Real-World Anti-Vascular Endothelial Growth Factor Therapy Outcomes in Myopic Choroidal Neovascularization

Abstract

Aim

Evaluation of real-world outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in the primary treatment of choroidal neovascularization (CNV) secondary to pathological myopia.

Patients and Methods

A retrospective cohort analysis of treatment naive patients with myopic CNV who received treatment with either intravitreal ranibizumab or aflibercept over a 12-year period from September 2007 to May 2020 was performed. Baseline features, treatment factors and outcomes were compared between younger and older patients and final visual outcome was assessed for associated factors.

Results

Thirty-seven eyes of 36 patients (24 females, 12 males) were included. Mean age was 58 years (range=26–89 years). Of these patients, 11/36 (31%) were ≤50 years of age and 25/36 (69%) were ≥51 years of age. Seventy-three percent (27/37) of eyes were phakic. One patient received bilateral treatment for myopic CNV. Median spherical equivalent was −8.50 diopters. Seventy percent (26/37) of eyes commenced primary treatment with ranibizumab, and 11/37 (30%) eyes commenced treatment with aflibercept. There were no significant differences between treatment factors and outcomes of younger and older patients. Median number of injections was 3 over a median follow-up period of 24.6 months. Mean CRT decreased by 126μm and median visual improvement was +6 letters. Analysis showed that younger age (p=0.022) and fewer injections (p=0.004) were associated with better visual outcomes.

Conclusion

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 edema. Increased frequency of administration of intravitreal anti-VEGF treatment did not improve vision. Younger age is associated with a better final visual outcome. These findings may help to advise patients about the prognosis of treatment and help guide treatment decisions.

Keywords:

• myopia
• pathological myopia
• choroidal neovascularization
• anti-VEGF intravitreal injection

Acknowledgments

The abstract of this paper was presented at the ARVO Annual Meeting 2019, as a poster presentation with interim findings. The poster’s abstract was published in “Poster Abstracts” in Investigative Ophthalmology & Visual Science, July 2019, Vol. 60, 5007: https://iovs.arvojournals.org/article.aspx?articleid=2744416.

Disclosure

Miss Joanna DaCosta reports travel grants from Alimera, outside the submitted work. Mr James Stephen Talks reports personal fees for advisory board and/or research from Bayer, Novartis, and Roche, outside the submitted work. The authors report no other conflicts of interest in this work.