Safety review of anti-VEGF therapy in patients with myopic choroidal neovascularization

ABSTRACT

Introduction

Anti-angiogenesis therapy with intravitreal anti-VEGF agents is now the standard-of-care treatment for myopic choroidal neovascularization (CNV).

Areas covered

We provide a critical review of the safety of all the anti-VEGF agents currently used for treating myopic CNV including ranibizumab, aflibercept, conbercept, bevacizumab, and ziv-aflibercept.

Expert opinion

Anti-VEGF therapy for myopic CNV with the currently available anti-VEGF drugs generally have favorable safety outcomes in the short-term. Nonetheless, ocular adverse events following anti-VEGF therapy for myopic CNV may develop and these include worsening or new development of myopic traction maculopathy, increased risk of retinal detachment, and progression of chorioretinal atrophy. Clinicians should be aware of these potential complications and evaluate them before and after anti-VEGF therapy.

KEYWORDS:

• Choroidal neovascularization
• anti-VEGF
• adverse events
• complications
• myopia

Article highlights

• Intravitreal injection of anti-VEGF agent is currently the standard of care treatment for patients with myopic CNV.

• Phase 3 randomized clinical trials have evaluated the efficacy and safety of various intravitreal anti-VEGF agents including ranibizumab, aflibercept and conbercept for myopic CNV and results demonstrated excellent short-term visual acuity gain with favorable safety outcomes up to 1 year.

• Patients with high myopia are more prone to develop various ocular complications especially peripheral retinal breaks, retinal detachment, myopic traction maculopathy and chorioretinal atrophy.

• Development of chorioretinal atrophy is a main cause of long-term visual loss in patients with myopic CNV and the use of verteporfin photodynamic therapy in combination with anti-VEGF therapy should be avoided.

• Anti-VEGF therapy in patients with myopic CNV may lead to progression or new onset of myopic traction maculopathy. Patients should be monitored regularly with optical coherence tomography after treatment to evaluate for potential myopic traction maculopathy and CNV recurrence.

Declaration of interest

TYY Lai is a consultant for Bayer, Boehringer Ingelheim, Genentech, Novartis, and Roche. There is no financial interest or conflict with the subject matter discussed in the manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they have received honoraria and lecture fees from Bayer, Novartis and Roche. All other peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.