Anti-vascular endothelial growth factor therapy for the treatment of myopic choroidal neovascularization

Abstract

Myopic choroidal neovascularization (CNV) is a sight-threatening condition which occurs in eyes with myopia, particularly in those with pathologic myopia. It is the most common cause of CNV among patients younger than 50 years. Hemorrhage and exudation from the CNV lesion may eventually result in scarring or chorioretinal atrophy. While myopic CNV was previously treated with focal laser photocoagulation or photodynamic therapy (PDT), the current treatment of choice is anti-vascular endothelial growth factor (VEGF) agents. Many studies have demonstrated the efficacy of intravitreal anti-VEGF agents in the treatment of myopic CNV. The RADIANCE study reported that intravitreal ranibizumab was superior to PDT in eyes with myopic CNV (at 3 months, both groups receiving intravitreal ranibizumab gained 10.5 and 10.6 letters vs 2.2 letters among patients receiving PDT). In addition, the study demonstrated similar visual outcomes in eyes treated on the basis of visual acuity stabilization or disease activity criteria. Other clinical studies have provided evidence for the efficacy of ranibizumab and aflibercept in the treatment of myopic CNV. This review addresses the epidemiology, pathophysiology, and imaging characteristics of myopic CNV, and discusses the evidence for the efficacy of anti-VEGF agents as compared to laser photocoagulation and PDT.

Three-year real-world outcomes of intravitreal anti-VEGF therapies in patients affected by myopic choroidal neovascularization

“…Treatment with these drugs has been shown to be superior to other management options (in terms of BCVA gain, CNV leakage, and quality of life) including laser photocoagulation, photodynamic therapy, and surgery. 5,12 Much of the data on various anti-VEGF agents has been acquired through rigorous randomized controlled trials (RCTs), with strict inclusion and exclusion criteria. 9,10 The results obtained may not be reproducible when treating a population potentially suffering from systemic comorbidities that can negatively affect the compliance to the planned follow up and treatment.…”

Intravitreal Anti-Vascular Endothelial Growth Factor Therapies for Retinal Disorders

“…Eyes with high myopia have elongated eyes in the anteroposterior axis and can develop secondary macular degeneration and subretinal choroidal neovascularization. The neovascularization is thought to result from mechanical chorioretinal stretching causing retinal and choroidal ischemia and the production of VEGF [ 28 , 29 ]. Eyes with POHS and posterior uveitis can develop chorioretinal scars and breaks in Bruch’s membrane in the macula that can lead to the development of subretinal choroidal neovascularization and vision loss.…”

Chorioretinal Atrophic Lesions Evolution in Patients with Quiescent Myopic Choroidal Neovascularization Followed for More Than 10 Years

“… 2 One of its most feared complications is the development of myopic choroidal neovascularization (CNV), which represents a well-established cause of CNV among patients younger than 50 years. 3 If left untreated, myopic CNV can cause scarring with enlargement of macular atrophy, which ultimately leads to irreversible visual loss. 4 Numerous treatment options have been applied for myopic CNV, including focal thermal laser photocoagulation, photodynamic therapy (PTD) with verteporfin, and intravitreal anti-VEGF therapy, the latter being considered the “gold standard treatment” for myopic CNV.…”