Abstract
BackgroundMyopic 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.MethodsThis 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.ResultsPatients 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.ConclusionZiv-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.
Highlights
Myopic choroidal neovascularization (CNV) is the most common sight-threatening complication associated with high myopia
According to the phase 3 RADIANCE trial [8], ranibizumab has been approved for the treatment of visual impairment due to myopic CNV; in addition, MYRROR, a phase 3 study, confirmed the efficacy and safety of intravitreal aflibercept in the treatment of CNV in pathological myopia patients [9]
Twenty eyes with active myopic CNV were collected beginning in March 2019, and the baseline demographic data of all patients, including age, sex, spherical equivalent, number of injections and CNV size, were recorded (Table 1)
Summary
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 zivaflibercept in patients with myopic CNV. The off-label use of bevacizumab and the introduction of ranibizumab and aflibercept as treatment modalities for myopic CNV showed promising results in preventing visual deterioration for a long time with minimal side effects [6, 7]. According to the phase 3 RADIANCE trial [8], ranibizumab has been approved for the treatment of visual impairment due to myopic CNV; in addition, MYRROR, a phase 3 study, confirmed the efficacy and safety of intravitreal aflibercept in the treatment of CNV in pathological myopia patients [9]
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