Long-term efficacy and recurrence of anti-vascular endothelial growth factor therapy for idiopathic choroidal neovascularization

Abstract

Background Choroidal neovascularization (CNV) is a common cause of visual impairment. Intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs has previously shown to be effective in the treatment of ICNV. However, the prognostic factors and incidence of recurrence has not been fully demonstrated. The follow-up period in previous studies has also been relatively short. This study aimed to evaluate the long-term efficacy and recurrence of intravitreal anti-vascular endothelial growth factor (VEGF) therapy for idiopathic choroidal neovascularization (ICNV). Methods This retrospective study included 35 patients (35 eyes) with ICNV from Peking University Third Hospital from July 2012 to October 2017. All patients received “treat and extend” treatment regimen. Intravitreal bevacizumab or ranibizumab were administered for each injection. To evaluate CNV recurrence, we continued to follow-up 27 of the 35 patients for at least 2 years after the initial diagnosis, and the longest period was 5 years. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded. Parameters that affect prognosis and recurrence were analyzed. Results The mean follow-up period after diagnosis was 168.0±34.82 months. BCVA improved from 56.20 ± 14.13 to 73.31±12.57 ( P <0.01) and CRT decreased from 353.6±98.70μm to 273.1±53.56μm ( P <0.001) one month after the last injection during the initial follow-up period. Better baseline BCVA indicated a better morphological improvement ( P =0.026) in OCT. Those with high baseline BCVA (more than 60 letters) showed significant resolution of CNV lesions ( P =0.036). 6 patients (22.2%) relapsed. The mean recurrence period was 90.83±49.02 weeks after diagnosis. Patients with recurrence underwent 3.67±0.816 injections, which was significantly higher than that without recurrence. The morphological improvement was compared between the two groups, and there was no statistical difference. Conclusions Intravitreal anti-VEGF therapy was effective on ICNV, which could improve BCVA and make CNV lesions subsided. High baseline BCVA indicated a better prognosis. Re-treatment with anti-VEGF could effectively lead to resolution of recurrent ICNV. Disease recurrence had no significant effect on the long-term prognosis and had no correlation with the morphological improvement during treatment, suggesting that long-term follow-up should be performed in all ICNV patients.