The 12-Month Outcome of Three Consecutive Monthly Intravitreal Injections of Ranibizumab for Myopic Choroidal Neovascularization

Abstract

Purpose: The aim of this study was to evaluate the 12-month outcomes, efficacy, and safety of three consecutive monthly intravitreal ranibizumab injections for myopic choroidal neovascularization (CNV). Methods: We retrospectively reviewed the medical records of 25 consecutive eyes that received a loading dose of three consecutive monthly intravitreal injections of ranibizumab for myopic CNV between February, 2008, and March, 2010, with a follow-up of 12 months. Eyes with persistent or recurrent CNV after 3 months received additional ranibizumab injections as needed. Patients' demographic data, best corrected visual acuity (BCVA), CNV findings on fluorescent angiography (FAG), central macular thickness (CMT) on optical coherence tomography (OCT), total number of treatments, and complications were recorded. Results: Mean baseline BCVA was 0.73 logarithm of the minimum angle of resolution (logMAR) (standard deviation [SD] 0.63), and improved significantly to 0.42 logMAR (SD 0.43) at 1 month, 0.38 logMAR (SD 0.47) at 2 months, 0.34 logMAR (SD 0.43) at 3 months, and 0.34 logMAR (SD 0.40) at 12 months (all P < 0.001, Wilcoxon signed-rank test). The average number of injections was 3.44 (SD 0.92). At 12 months, mean improvement was 2.88 lines (SD 2.35), and 20 eyes (80%) showed a gain of at least one line after treatment. At 3 months, OCT showed significant reduction in CMT (P = 0.012, two-tailed t-test), and FAG showed significant reduction of mean CNV size from 0.3 (SD 0.16) to 0.19 (SD 0.12) disc area (P = 0.007, two-tailed t-test). No angiographic leakage was evident at 3 months in 21 eyes (84%); four eyes (16%) required additional injections for persistent leakage. Two eyes (8%) had recurrent CNV during follow-up and required retreatment. No complications were noted after treatment. Conclusions: An initial loading dose of three ranibizumab injections is safe and effective in treating myopic CNV, with visual improvement maintained over 12 months.

One‐year outcome of two different initial dosing regimens of intravitreal ranibizumab for myopic choroidal neovascularization

“…Other longer-term studies with at least 1 year of follow-up showed 65-92.7% of eyes with myopic CNV achieved visual improvement of at least one line after intravitreal injections of ranibizumab (Lai et al 2009;Mones et al 2009;Lalloum et al 2010;Silva et al 2010;Calvo-Gonzalez et al 2011;Lorenzo et al 2011;Wu & Kung 2012;Wolf et al 2014), and these results seemed superior to those in eyes treated with PDT at 1 year. However, the variable results are probably due to different study designs, such as variety in CNV location, size and severity, percentages of eyes with prior treatment, follow-up durations, baseline visual acuities and sample sizes.…”

“…In group 2, the mean logMAR BCVA significantly improved from 0.35 to 0.28 between 1 and 2 months and from 0.28 to 0.23 between 2 and 3 months (p = 0.003 and 0.041, respectively). Mones et al 2009;Gharbiya et al 2010;Lalloum et al 2010;Silva et al 2010;Vadala et al 2010;Calvo-Gonzalez et al 2011;Lorenzo et al 2011;Franqueira et al 2012;Ng et al 2012;Wu & Kung 2012;Wolf et al 2014). In a short-term study, 65% of the 26 eyes treated with intravitreal ranibizumab for myopic CNV gained at least 1 line at 3 months after a mean of 1.9 treatments (Silva et al 2008).…”

“…In CNV secondary to pathologic myopia, case series have shown significant vision improvement with anti-VEGF drugs (Cohen 2009;Ng et al 2012). Although there were fewer reports than for bevacizumab (Avastin, Genentech, South San Francisco, CA), treatment with ranibizumab (Lucentis, Novartis, Basel, Switzerland) in myopic CNV resulted in significant visual improvement (Konstantinidis et al 2009;Lai et al 2009;Mones et al 2009;Gharbiya et al 2010;Lalloum et al 2010;Silva et al 2010;Vadala et al 2010;Calvo-Gonzalez et al 2011;Lorenzo et al 2011;Franqueira et al 2012;Ng et al 2012;Wu & Kung 2012;Wolf et al 2014). However, different protocols with different initial dosing regimens of ranibizumab were adopted in these studies, and there was still no consensus on whether a loading dose with three consecutive monthly injections of ranibizumab is safer and more effective than a single initial injection for treating CNV secondary to pathologic myopia.…”

Choroidale Neovaskularisation (CNV) bei pathologischer Myopie (PM): epidemiologische Daten aus einer Versorgungsforschungsstudie bei Ophthalmologen in Deutschland

“…Auch bei der Behandlung der CNV bei PM gibt es Hinweise auf bessere Resultate durch die Therapie mit Anti-VEGF. Aus Studien mit Ranibizumab gibt es bereits erste Erfolg versprechende Ergebnisse [13][14][15][16][17][18][19][20]. Die Ergebnisse aus randomisierten, kontrollierten Studien mit Ranibizumab bei myoper CNV sowie die diesbezüglichen Phase-III-Studien sind zwar abgeschlossen, aber noch nicht vollständig publiziert [www.clinicaltrials.gov].…”

Therapeutic effect of intravitreal injections of ranibizumab for the treatment of macular choroidal neovascularization caused by pathological myopia

“…Regarding the injection number option, we adopted the pro re nata method, similar to Wakabayashi et al (13), in which the administration of further injections was determined based on the first injection curve effect. Few researchers have selected the classic treatment, which is suitable for exudative AMD; in the classic treatment, the decision of whether to re-treat is based upon the evaluation following three consecutive injections (21)(22)(23). Different treatment options in the previous studies may have been based on the facts that the leakage, edema and lesion areas of pathological myopia-induced CNV lesions are lower than those of exudative AMD, and the lesions are mainly located under the macula lutea.…”