Pilot study of ziv-aflibercept in myopic choroidal neovascularisation patients

Abstract

Background Myopic choroidal neovascularization (CNV) is the most common sight-threatening complication associated with high myopia. The present study evaluated the efficacy and safety of the intravitreal injection of ziv-aflibercept in patients with myopic CNV. Methods This prospective interventional study was conducted on 20 eyes of 20 patients with active myopic CNV. Twelve patients were 40 years or older. This study was performed in the Ophthalmology Department of Tanta University Eye Hospital, Tanta University, Egypt. Optical coherence tomography (OCT) was performed for all patients at baseline and monthly after injection during the 6-month follow up period. The main outcome measures were changes in BCVA and CMT. The exploratory outcome measures were CNV size, IOP and the number of injections needed in each age group during the study period. Results Patients with myopic CNV younger than 40 years needed fewer injections (2.00 ± 0.76) than patients older than 40 years (2.50 ± 1.00), with no statistical significance detected between the two groups (p-value 0.246). CNV was smaller in the younger age group (p-value 0.209), best corrected visual acuity (BCVA) improved significantly in the younger and older age groups (p-values 0.001 and 0.028, respectively), and central macular thickness (CMT) decreased significantly after 6 months, from 242.88 ± 23.83 μm to 191.13 ± 13.83 μm in the younger age group and from 251.33 ± 26.60 μm to 197.08 ± 17.64 μm in the older age group (p = 0.001). No significant correlation was found between the final BCVA and either the spherical equivalent or central macular thickness after 6 months, with p-values of 0.135 and 0.145, respectively. No significant changes in IOP were detected in either group after the intravitreal injection. Conclusion Ziv-aflibercept is a highly effective and safe drug in cases of active myopic CNV; however, a larger number of patients and a longer follow-up period are needed to confirm our results. This study was retrospectively registered at clinicaltrials.gov (ID: NCT04290195) on 26-2-2020.

A retrospective analysis on comparison of optical coherence tomography manifestations among AMD, CEC, PM and ICN and its relationship with vision

“…Most MCN patients have macular edema symptoms that may be accompanied by vision changes ( 13 ). Clinicians need to accurately evaluate patients’ vision in a timely manner to enable scientific and reasonable interventions to be implemented to prevent visual impairment ( 14 , 15 ).…”

Myopic macular diseases: A review

“…Off‐label use of ziv‐aflibercept for myopic MNV has been evaluated in a few case series 65–67 . In the study by Braimah et al, 65 nine eyes with myopic MNV were treated with ziv‐aflibercept and the mean logMAR BCVA improved from 0.93 to 0.15 over 3 to 6 months after a mean of 1.2 ziv‐aflibercept injection.…”

“…In the study by Braimah et al, 65 nine eyes with myopic MNV were treated with ziv‐aflibercept and the mean logMAR BCVA improved from 0.93 to 0.15 over 3 to 6 months after a mean of 1.2 ziv‐aflibercept injection. In another study, Nawar et al prospectively treated 20 eyes with myopic MNV using ziv‐aflibercept and the mean logMAR BCVA improved significantly from 0.77 to 0.42 after 6 months 66 . The safety of ziv‐aflibercept for myopic MNV appeared to be favourable as a study by Singh et al which assessed the safety of more than 5900 intravitreal ziv‐aflibercept injections for all macular pathologies worldwide have shown absence of adverse events in myopic MNV eyes treated with ziv‐afliberecept 67 …”

“…Off-label use of ziv-aflibercept for myopic MNV has been evaluated in a few case series. [65][66][67] In the study by Braimah et al, 65 nine eyes with myopic MNV were treated with ziv-aflibercept and the mean logMAR BCVA improved from 0.93 to 0.15 over 3 to 6 months after a mean of 1.2 ziv-aflibercept injection. In another study, Nawar et al prospectively treated 20 eyes with myopic MNV using ziv-aflibercept and the mean logMAR BCVA improved significantly from 0.77 to 0.42 after 6 months.…”