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

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.

This is a preview of subscription content, access via your institution.

Fig. 1

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):1297–1305

    PubMed  Article  Google 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):1573–1581

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Ohno-Matsui K (2017) What is the fundamental nature of pathologic myopia? Retina 37(6):1043–1048

    PubMed  Article  Google Scholar 

  4. 4.

    Grossniklaus HE, Green WR (1992) Pathologic findings in pathologic myopia. Retina 12(2):127–133

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    Lai TY, Cheung CM (2016) Myopic choroidal neovascularization: diagnosis and treatment. Retina 36(9):1614–1621

    CAS  PubMed  Article  Google 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):289–296

    PubMed  Article  Google 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):1690–1711

    PubMed  Article  Google 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):1375–1392

    CAS  PubMed  Article  Google 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):2056–2061

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    Lai TY (2012) Anti-vascular endothelial growth factor therapy for myopic choroidal neovascularization: do we need more evidence? Retina 32(8):1443–1445

    PubMed  Article  Google 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):682–692

    PubMed  Article  Google 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–e620

    CAS  PubMed  Article  Google 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):750–756

    PubMed  Article  Google 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):129–133

    CAS  PubMed  PubMed Central  Article  Google 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):407–412

    PubMed  Article  Google 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):1944–1945

    PubMed  Article  Google 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):709–715

    CAS  Article  Google 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):103–109

    CAS  PubMed  Article  Google 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):1004–1011

    CAS  Article  Google 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):39–44

    CAS  PubMed  Article  Google 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):1447–1450

    PubMed  Article  Google 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):28–33

    PubMed  Article  Google Scholar 

  23. 23.

    Gass JDM (1987) Stereoscopic atlas of macular diseases: diagnosis and treatment, 3rd edn. Mosby, St. Louis

    Google 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):1985–1994

    CAS  PubMed  Article  Google 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):1220–1227

    PubMed  Article  Google Scholar 

  26. 26.

    El Matri L, Chebil A, Kort F (2015) Current and emerging treatment options for myopic choroidal neovascularization. Clin Ophthalmol 9:733–744

    PubMed  PubMed Central  Article  Google 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):529–534

    CAS  PubMed  Article  Google 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)

    CAS  Article  Google 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):399–406

    PubMed  Article  Google 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):483–486

    CAS  PubMed  Article  Google 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):2450–2456

    CAS  PubMed  Article  Google 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):133–142

    CAS  PubMed  Article  Google 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):1055–1064

    CAS  PubMed  Article  Google 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–S42

    PubMed  PubMed Central  Google 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):1578–1583

    Google 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):1837–1848

    CAS  PubMed  Article  Google Scholar 

Download references

Funding

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

Author information

Affiliations

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.

Corresponding author

Correspondence to Ewa Wasiluk.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wasiluk, E., Wojnar, M., Obuchowska, I. et al. Long-term outcomes of the intravitreal injection of ranibizumab for the treatment of choroidal neovascularization secondary to pathologic myopia. Int Ophthalmol 40, 833–839 (2020). https://doi.org/10.1007/s10792-019-01247-w

Download citation

Keywords

  • Myopic CNV
  • Intravitreal anti-VEGF
  • Ranibizumab
  • Pathologic myopia