Current and emerging treatment options for myopic choroidal neovascularization

Figures & data

Table 1 Summary of published studies on treatment for myopic choroidal neovascularization

Study	Number of eyes	Treatment	Follow-up	Main results
Hamelin et al^Citation8	32	Macular translocation versus surgical removal of CNV	14±15 months	BCVA was statistically better after macular translocation than after surgical removal
Fujikado et al^Citation9	11	Foveal translocation with 360-degree retinotomy	6.2 months	Vision improved in eight eyes, was unchanged in two eyes, and worsened in one eye. Seven of 11 eyes (64%) had a final visual acuity of 20/50 or better
Yamada et al^Citation10	32	Full macular translocation	1 year	The final VA was significantly better in mCNV than in exudative age-related macular degeneration
Sakimoto et al^Citation11	60	Full macular translocation	5 years	BCVA values at 1, 3, and 5 years postoperatively significantly improved (P<0.001) to 0.54 at 1 year and then remained stable
Hayashi et al^Citation14	43	PDT	1 year	The BCVA improved by more than two Snellen lines in 16.3%, decreased in 14%, and remained stable in 69.7%
Verteporfin in photo-dynamic therapy (VIP) study^Citation12	120	PDT	2 years	Stabilization of VA in 72%; there was no statistically significant benefit in the visual outcome at 24 months
Chen et al^Citation15	33	PDT	2 years	Improvement was much more evident in the younger group, although it was not statistically significant at every follow-up time point
Hayashi et al^Citation16	46	PDT	4 years	The BCVA did not change significantly
Coutinho et al^Citation17	43	PDT	5 years	VA stabilized or improved in 65% of the eyes after 24 months, with no significant VA change between month 24 and month 60
Varano et al^Citation18	19	PDT	10 years	Eyes with subfoveal CNV progressively worsened, while in the eyes with juxtafoveal CNV (63%), BCVA improved
Yamamoto et al^Citation23	11	IVB	153 days (range: 35–224)	VA improved by a mean of +3.5 lines (range: −1 to +8 lines)
Sakaguchi et al^Citation24	8	IVB	3–7 months	The BCVA improved to two or more lines in six eyes (75%) and remained the same in two eyes (25%)
Scupola et al^Citation31	15	IVB	1 year	The change in BCVA at 1, 6, and 12 months was statistically significant (P<0.05). Eight eyes (53.3%) had BCVA improved by ≥2 lines at 1-year follow-up; six eyes (40%) had an improvement of ≥3 lines. Seven patients (46.7%) had stable vision 12 months after treatment
Ruiz-Moreno et al^Citation34	19	IVB	2 years	BCVA gain decreases and was no longer significant by the end of the second year
Hayashi et al^Citation40	75	IVB	2 years	BCVA in eyes with a subfoveal CNV was not significant. BCVA in eyes with nonsubfoveal CNV was significantly improved
Voykov et al^Citation35	21	IVB	2 years	Mean logMAR BCVA improved from 0.64 at baseline to 0.55 after 1 year (P=0.32) and remained at 0.55 at 2 years (P=0.23)
Nakanishi et al^Citation36	23	IVB	2 years	BCVA improved after 1 month (P<0.001); the improvement was maintained at 24 months, (P<0.005)
Gharbiya et al^Citation37	20	IVB	2 years	BCVA improved significantly (P<0.05)
Peiretti et al^Citation41	21	IVB	4 years	71.4% of the eyes demonstrated an improvement of ≥ 1 line on the Snellen chart, 14.3% showed and 14.3% lost one line
Oishi et al^Citation42	22	IVB	4 years	BCVA improved after 1, 2, and 3 years. The effect slightly declined to marginally nonsignificant levels after 4 years
Liang et al^Citation44	9	posterior sub-Tenon injection of bevacizumab	77.56 weeks	BCVA improved by a mean of −0.38 logMAR (>3 lines)
El Matri et al^Citation38	80	PDT versus IVB	1 year	In the IVB group, BCVA was significantly better at 3 months and 6 months than at baseline, but not at 12 months; in the PDT group, mean BCVA was positively improved at 3 months and 6 months, which was not significantly different from that at baseline, then decreased at 12 months
Baba et al^Citation32	24	PDT versus IVB	2 years	The BCVA did not change after PDT but was significantly improved after IVB
Ikuno et al^Citation32	30	PDT versus IVB	2 years	IVB provides a significantly better BCVA than PDT for mCNV over the long term
Parodi et al^Citation6	54	IVB versus PDT versus laser	2 years	IVB offers the best functional results during a 2-year follow-up
Silva et al^Citation45	26	IVR	6 months	VA improved significantly at 1 month, 3 months, and 6 months
Tufail et al^Citation50 (REPAIR)	65	IVR	1 year	BCVA improved after 1 year
Lai et al^Citation46	16	IVR	1 year	At 1 month and 12 months, the mean BCVA improved significantly
Silva et al^Citation47	34	IVR	1 year	BCVA improved to 12-month follow-up, and the difference was statistically significant
Calvo-Gonzalez et al^Citation39	67	IVR	15.9 months	BCVA improved by 7.8 letters after the first injection, 12.5 letters after three injections, and 12 letters by end of follow-up
Vadala et al^Citation48	40	IVR	18 months	Mean final VA improved in 82.5% of patients
Franqueira et al^Citation53	40	IVR	3 years	High proportion of patients gaining or stabilizing BCVA at a 3-year follow-up
Freitas-da-Costa et al^Citation56	67	IVR	5 years	BCVA was significant at 2 years, and this gain remained significantly stable for 5 years
Wolf et al^Citation49 (RADIANCE)	277	IVR versus PDT	1 year	IVR provided superior BCVA gains versus PDT up to month 3. Over 12 months, individualized ranibizumab treatment was effective in improving and sustaining BCVA
Iacono et al^Citation53	55	IVB versus IVR	18 months	IVR achieved greater efficacy than IVB and the IVR subgroup achieved a faster central macular thickness
Ruiz-Moreno et al^Citation55	92	IVB versus IVR	4 years	IVB and IVR are effective therapies and show similar clinical effects; VA gain is maintained at 4-year follow-up
Rinaldi et al^Citation58	20	IVP	48 weeks	After IVP, a significant decrease in foveal thickness occurred and at the end of follow-up, CNV closure was obtained in all eyes. An improvement of functional parameters was recorded in all patients
Kitagawa et al^Citation59	31	IVP	1 year	VA and retinal sensitivity were maintained, while metamorphopsia was improved 1 year after IVP
Kitagawa et al^Citation60	28	IVP versus IVB	1 year	Changes in VA at 1 year did not differ significantly between IVB and IVP; IVB improved mean retinal sensitivity with fewer injections than IVP

Abbreviations: BCVA, best-corrected visual acuity; CNV, choroidal neovascularization; IVB, intravitreal bevacizumab; IVP, intravitreal pegaptanib; IVR, intravitreal ranibizumab; logMAR, logarithm of the minimum angle of resolution; mCNV, myopic choroidal neovascularization; PDT, photodynamic therapy; REPAIR, Ranibizumab for treatment of CNV secondary to Pathological myopia: An individualized Regimen; VA, visual acuity.

Figure 1 Development of CRA around the subfoveal CNV treated with IVB injection in the right eye of a 34-year-old woman with a refractive error of −10.0 diopters and axial length of 27.8 mm.

Notes: (A) Fundus photograph of the right eye shows small fibrovascular membrane 1 month after IVB; (B) 1 year after IVB, the right fundus shows a regressed CNV with CRA around; (C) 3 years after IVB, the right fundus shows a large CRA; (D) 5 years after IVB, the right fundus shows a larger central area of CRA.
Abbreviations: CNV, choroidal neovascularization; CRA, chorioretinal atrophy; IVB, intravitreal bevacizumab.

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