Prognostic factors for visual outcomes 2-years after intravitreal bevacizumab for myopic choroidal neovascularization

Abstract

Purpose To determine the pre-treatment ocular factors significantly associated with the visual outcome 24 months after intravitreal bevacizumab (IVB) for myopic choroidal neovascularization (mCNV). Methods A total of 23 eyes of 23 patients with mCNV were treated with IVB followed by as needed therapy. The efficacy of IVB was evaluated by the best-corrected visual acuity (BCVA) at 24 months after the initial treatment. Forward stepwise multiple linear regression analyses were performed to evaluate the influence of pre-treatment factors on the BCVA and the improvement of the BCVA at 24 months. Results The mean pre-IVB BCVA was 0.74±0.30 logarithm of the minimum angle of resolution (logMAR) units, and it improved to 0.43±0.31 logMAR units after 1 month (Po0.001, paired t-test). The improvement was maintained at 24 months (0.46 ± 0.40, Po0.005). The mean number of IVB performed during the 24 months was 1.35 ± 0.71. Forward stepwise regression analysis showed that the pre-IVB CNV size (standardized b ¼ 0.52, Po0.01) and BCVA (standardized b ¼ À0.44, Po0.05) significantly affected the visual acuity change after 24 months. The CNV size was the only factor that significantly affected the BCVA after 24 months (standardized b ¼ 0.56, Po0.01). Conclusions IVB with as needed therapy for mCNV led to a rapid and sustained visual improvement. Smaller CNV size was a significant prognostic factor that predicts better visual acuity. Patients with lower pre-treatment BCVA had better visual recovery than those with better pre-treatment BCVA, however, this may be due to a ceiling/floor effect.

Long-term outcome of intravitreal anti-vascular endothelial growth factor therapy with bevacizumab or ranibizumab as primary treatment for subfoveal myopic choroidal neovascularization

“…In addition, we also found that the size of myopic CNV was negatively correlated with the extent of visual improvement at 2 years. The result supports the findings by Nakanishi et al, 28 in which the size of myopic CNV is a significant factor in influencing the final visual acuity after intravitreal bevacizumab treatment.…”

“…[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Although the short-term results have demonstrated significant visual improvement following anti-VEGF therapy, the longer term visual outcomes appeared more variable. 14,[26][27][28] In addition, many previous studies have included both treatment naïve cases and previously treated eyes, as well as subfoveal and non-subfoveal CNV in the series, making comparison of results more difficult. The main strengths of our current study included the relatively long follow-up duration of 2 years and the homogeneity of cases with only treatment naïve subfoveal myopic CNV included in the series.…”

“…14,27 Previous studies that have evaluated the use of anti-VEGF therapy in myopic CNV were also rather heterogeneous, as the studies have included prior treated eyes as well as non-subfoveal CNV. [28][29][30] In order to further assess the long-term efficacy of anti-VEGF therapy for myopic CNV, we evaluated the 2-year outcomes in the use of intravitreal bevacizumab and ranibizumab as the primary treatment for subfoveal myopic CNV. We also evaluated the prognostic factors that might influence the visual outcomes following anti-VEGF therapy for myopic CNV.…”

Avaliação dos Resultados do Tratamento Antiangiogénico na Neovascularização Coroideia Associada à Miopia Patológica

“…De facto, uma melhor MAVC inicial está associada a menos dano nos fotorreceptores, que poderá explicar os melhores resultados. 15,25 No entanto, outros estudos mostram que uma MAVC inicial mais baixa cursa com melhores resultados após tratamento, 13 de acordo com o ceiling floor effect. Os autores consideram que uma melhor MAVC inicial terá menor probabilidade de melhorar (ceiling effect), enquanto doentes com pior MAVC inicial terão mais probabilidade de melhorar (floor effect).…”

“…[17][18][19][20] Surgiu assim a necessidade de introduzir novas terapêuticas, nomeadamente as injecções intravítreas de agentes anti-VEGF, que mostraram melhores resultados no tratamento. 4,6,[21][22][23][24][25] A terapêutica antiangiogénica, nomeadamente o bevacizumab e o ranibizumab, estão aprovados para o tratamento da neovascularização coroideia secundária à degenerescência macular da idade (DMI), tendo também mostrado claros benefícios clínicos na neovascularização associada a outras situações de causa inflamatória ou vascular. 3,9,26 Face à evidência de eficácia e segurança com o uso destes agentes, a sua utilização na NVC associada à miopia patológica é atualmente considerada terapêutica de primeira linha.…”