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Long-term outcomes of the intravitreal injection of ranibizumab for the treatment of choroidal neovascularization secondary to pathologic myopia

  • Ewa WasilukEmail author
  • Malgorzata Wojnar
  • Iwona Obuchowska
  • Zofia Mariak
Original Paper
  • 22 Downloads

Abstract

Purpose

To analyze the long-term outcomes and safety of intravitreal ranibizumab injections in myopic choroidal neovascularization (CNV).

Methods

A retrospective non-randomized analysis of consecutive cases included 17 eyes from 17 patients with subfoveal myopic CNV, treated with intravitreal ranibizumab with at least 30-month follow-up. The patients received three injections monthly, followed by pro re nata regimen. Best-corrected visual acuity (BCVA) measurement, optical coherence tomography and fluorescein angiography were carried out at the baseline and at monthly intervals thereafter.

Results

Mean follow-up period was 51 months (range 30–98 months). In 12 patients (70.6%), BCVA improved by at least 1 Snellen line, with at least 3-line improvement observed in the case of 8 eyes (47%). Mean central foveal thickness (CFT) decreased from 384.65 ± 103.3 µm at the baseline to 264 ± 86.2 µm at the last follow-up examination (p < 0.001). The final OCT examination revealed 59% (10/17) eyes with CNV-related macular atrophy. Mean number of injections over the follow-up period was 4.82 ± 2.04 per person. Nine patients (53%) required re-injection of the anti-VEGF agent; the mean number of re-injections in this group was 3.44 ± 1.34 per person (range 2–6). No significant adverse events were recorded during the study period.

Conclusions

Intravitreal ranibizumab is an effective and safe treatment for CNV secondary to pathologic myopia, contributing to long-term vision improvement and CFT reduction.

Keywords

Myopic CNV Intravitreal anti-VEGF Ranibizumab Pathologic myopia 

Notes

Authors’ contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by EW and MW. The first draft of the manuscript was written by EW and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Yoshida T, Ohno-Matsui K, Yasuzumi K, Kojima A, Shimada N, Futagami S et al (2003) Myopic choroidal neovascularization: a 10-year follow-up. Ophthalmology 110(7):1297–1305CrossRefGoogle Scholar
  2. 2.
    Avila MP, Weiter JJ, Jalkh AE, Trempe CL, Pruett RC, Schepens CL (1984) Natural history of choroidal neovascularization in degenerative myopia. Ophthalmology 91(12):1573–1581CrossRefGoogle Scholar
  3. 3.
    Ohno-Matsui K (2017) What is the fundamental nature of pathologic myopia? Retina 37(6):1043–1048CrossRefGoogle Scholar
  4. 4.
    Grossniklaus HE, Green WR (1992) Pathologic findings in pathologic myopia. Retina 12(2):127–133CrossRefGoogle Scholar
  5. 5.
    Lai TY, Cheung CM (2016) Myopic choroidal neovascularization: diagnosis and treatment. Retina 36(9):1614–1621CrossRefGoogle Scholar
  6. 6.
    Wong TY, Ohno-Matsui K, Leveziel N, Holz FG, Lai TY, Yu HG et al (2015) Myopic choroidal neovascularisation: current concepts and update on clinical management. Br J Ophthalmol 99(3):289–296CrossRefGoogle Scholar
  7. 7.
    Cheung CMG, Arnold JJ, Holz FG, Park KH, Lai TYY, Larsen M et al (2017) Myopic choroidal neovascularization: review, guidance, and consensus statement on management. Ophthalmology 124(11):1690–1711CrossRefGoogle Scholar
  8. 8.
    Wang E, Chen Y (2013) Intravitreal anti-vascular endothelial growth factor for choroidal neovascularization secondary to pathologic myopia: systematic review and meta-analysis. Retina 33(7):1375–1392CrossRefGoogle Scholar
  9. 9.
    Wu TT, Kung YH (2017) Five-year outcomes of intravitreal injection of ranibizumab for the treatment of myopic choroidal neovascularization. Retina 37(11):2056–2061CrossRefGoogle Scholar
  10. 10.
    Lai TY (2012) Anti-vascular endothelial growth factor therapy for myopic choroidal neovascularization: do we need more evidence? Retina 32(8):1443–1445CrossRefGoogle Scholar
  11. 11.
    Wolf S, Balciuniene VJ, Laganovska G, Menchini U, Ohno-Matsui K, Sharma T et al (2014) RADIANCE: a randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia. Ophthalmology 121(3):682–692CrossRefGoogle Scholar
  12. 12.
    Kung YH, Wu TT, Huang YH (2014) One-year outcome of two different initial dosing regimens of intravitreal ranibizumab for myopic choroidal neovascularization. Acta Ophthalmol 92(8):e615–e620CrossRefGoogle Scholar
  13. 13.
    Lai TY, Chan WM, Liu DT, Lam DS (2009) Intravitreal ranibizumab for the primary treatment of choroidal neovascularization secondary to pathologic myopia. Retina 29(6):750–756CrossRefGoogle Scholar
  14. 14.
    Wu TT, Kung YH (2012) The 12-month outcome of three consecutive monthly intravitreal injections of ranibizumab for myopic choroidal neovascularization. J Ocul Pharmacol Ther 28(2):129–133CrossRefGoogle Scholar
  15. 15.
    Silva RM, Ruiz-Moreno JM, Rosa P, Carneiro A, Nascimento J, Rito LF et al (2010) Intravitreal ranibizumab for myopic choroidal neovascularization: 12-month results. Retina 30(3):407–412CrossRefGoogle Scholar
  16. 16.
    Tufail A, Narendran N, Patel PJ, Sivaprasad S, Amoaku W, Browning AC et al (2013) Ranibizumab in myopic choroidal neovascularization: the 12-month results from the REPAIR study. Ophthalmology 120(9):1944–1945CrossRefGoogle Scholar
  17. 17.
    Tufail A, Patel PJ, Sivaprasad S, Amoaku W, Browning AC, Cole M et al (2013) Ranibizumab for the treatment of choroidal neovascularisation secondary to pathological myopia: interim analysis of the REPAIR study. Eye (Lond) 27(6):709–715CrossRefGoogle Scholar
  18. 18.
    Lorenzo D, Arias L, Alcubierre R, Pujol O, Caminal JM, Rubio M et al (2011) Intravitreal ranibizumab for choroidal neovascularization secondary to pathological myopia: 12-month follow-up. Ophthalmologica 226(3):103–109CrossRefGoogle Scholar
  19. 19.
    Lai TY, Luk FO, Lee GK, Lam DS (2012) Long-term outcome of intravitreal anti-vascular endothelial growth factor therapy with bevacizumab or ranibizumab as primary treatment for subfoveal myopic choroidal neovascularization. Eye (Lond) 26(7):1004–1011CrossRefGoogle Scholar
  20. 20.
    Franqueira N, Cachulo ML, Pires I, Fonseca P, Marques I, Figueira J et al (2012) Long-term follow-up of myopic choroidal neovascularization treated with ranibizumab. Ophthalmologica 227(1):39–44CrossRefGoogle Scholar
  21. 21.
    Ruiz-Moreno JM, Arias L, Montero JA, Carneiro A, Silva R (2013) Intravitreal anti-VEGF therapy for choroidal neovascularisation secondary to pathological myopia: 4-year outcome. Br J Ophthalmol 97(11):1447–1450CrossRefGoogle Scholar
  22. 22.
    Peiretti E, Vinci M, Fossarello M (2012) Intravitreal bevacizumab as a treatment for choroidal neovascularisation secondary to myopia: 4-year study results. Can J Ophthalmol 47(1):28–33CrossRefGoogle Scholar
  23. 23.
    Gass JDM (1987) Stereoscopic atlas of macular diseases: diagnosis and treatment, 3rd edn. Mosby, St. LouisGoogle Scholar
  24. 24.
    Chen Y, Sharma T, Li X, Song Y, Chang Q, Lin R et al (2019) Ranibizumab versus verteporfin photodynamic therapy in Asian patients with myopic choroidal neovascularization: brilliance, a 12-month, randomized, double-masked study. Retina 39(10):1985–1994CrossRefGoogle Scholar
  25. 25.
    Ikuno Y, Ohno-Matsui K, Wong TY, Korobelnik JF, Vitti R, Li T et al (2015) Intravitreal aflibercept injection in patients with myopic choroidal neovascularization: the MYRROR study. Ophthalmology 122(6):1220–1227CrossRefGoogle Scholar
  26. 26.
    El Matri L, Chebil A, Kort F (2015) Current and emerging treatment options for myopic choroidal neovascularization. Clin Ophthalmol 9:733–744CrossRefGoogle Scholar
  27. 27.
    Calvo-Gonzalez C, Reche-Frutos J, Donate J, Fernandez-Perez C, Garcia-Feijoo J (2011) Intravitreal ranibizumab for myopic choroidal neovascularization: factors predictive of visual outcome and need for retreatment. Am J Ophthalmol 151(3):529–534CrossRefGoogle Scholar
  28. 28.
    Mones JM, Amselem L, Serrano A, Garcia M, Hijano M (2009) Intravitreal ranibizumab for choroidal neovascularization secondary to pathologic myopia: 12-month results. Eye (Lond) 23(6):1275–1280 (quiz 81) CrossRefGoogle Scholar
  29. 29.
    Lalloum F, Souied EH, Bastuji-Garin S, Puche N, Querques G, Glacet-Bernard A et al (2010) Intravitreal ranibizumab for choroidal neovascularization complicating pathologic myopia. Retina 30(3):399–406CrossRefGoogle Scholar
  30. 30.
    Hefner L, Gerding H (2017) 6-Year results of CNV secondary to pathological myopia treated with ranibizumab. Klin Monbl Augenheilkd 234(4):483–486CrossRefGoogle Scholar
  31. 31.
    Ruiz-Moreno JM, Montero JA, Araiz J, Arias L, Garcia-Layana A, Carneiro A et al (2015) Intravitreal anti-vascular endothelial growth factor therapy for choroidal neovascularization secondary to pathologic myopia: six years outcome. Retina 35(12):2450–2456CrossRefGoogle Scholar
  32. 32.
    Pastore MR, Capuano V, Bruyere E, Miere A, Corbelli E, Querques L et al (2018) Nine-year outcome of ranibizumab monotherapy for choroidal neovascularization secondary to pathologic myopia. Ophthalmologica 239(2–3):133–142CrossRefGoogle Scholar
  33. 33.
    Kasahara K, Moriyama M, Morohoshi K, Yoshida T, Simada N, Nagaoka N et al (2017) Six-year outcomes of intravitreal bevacizumab for choroidal neovascularization in patients with pathologic myopia. Retina 37(6):1055–1064CrossRefGoogle Scholar
  34. 34.
    Ventrice P, Leporini C, Aloe JF, Greco E, Leuzzi G, Marrazzo G et al (2013) Anti-vascular endothelial growth factor drugs safety and efficacy in ophthalmic diseases. J Pharmacol Pharmacother 4(Suppl 1):S38–S42PubMedPubMedCentralGoogle Scholar
  35. 35.
    Zhu H, Wang FH, Sun XD (2013) Anti-vascular endothelial growth factor: the future treatment of choroidal neovascularization in pathologic myopia? Chin Med J (Engl) 126(8):1578–1583Google Scholar
  36. 36.
    Hashemi S, Faramarzi MA, Ghasemi Falavarjani K, Abdollahi M (2014) Bevacizumab for choroidal neovascularization secondary to age-related macular degeneration and pathological myopia. Expert Opin Biol Ther 14(12):1837–1848CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of OphthalmologyThe Medical University of Bialystok Clinical HospitalBialystokPoland

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