Abstract
BackgroundThe current study aimed to evaluate the efficacy of intravitreal aflibercept injections as the primary treatment for subfoveal/juxtafoveal myopic choroidal neovascularization (CNV) by using optical coherence tomography (OCT). Optical coherence tomography angiography (OCTA) was further used for some patients to detect the changes of CNV after treatment.MethodsIn the present study, 21 treatment-naive eyes of 21 patients with subfoveal/juxtafoveal myopic CNV received primary intravitreal aflibercept injections and were under follow-up for a minimum duration of 12 months. Among the 21 patients, 12 underwent OCTA to evaluate the changes in central foveal thickness, selected CNV area, and flow area.ResultsThe mean best-corrected visual acuity (BCVA) pertaining to all the patients significantly improved from the baseline value of 0.7 to 0.3 logMAR after treatment for 12 months (P = 0.001). However, the improvements in the median BCVA after treatment for three and 12 months were not statistically significant in the younger group (< 50 years), compared to the older group (≥ 50 years). One aflibercept injection resolved the CNV in 47.6% (10/21) of the patients. The younger group displayed greater improvement in the median central foveal thickness, compared to the older group.OCTA revealed interlacing or disorganized pattern at the level of the outer retinal layer in 12 subjects with myopic CNV. After 3 months of treatment, both groups displayed a decrease in the size of the selected CNV area and flow area. The interlacing group displayed a trend towards better anatomical improvements.ConclusionIntravitreal aflibercept injection provides long-term improvement in visual acuity in patients with myopic CNV. Eyes with the interlacing pattern on OCTA displayed a greater decrease in size and flow after aflibercept injection.Trial registrationBefore data collection, written informed consent was obtained from each participant, whose identity information was protected by encryption and conversion to a non-identifiable format and removing data links. This study was approved by the Institutional Review Board of Kaohsiung Veterans General Hospital (KSVGH21-CT1–17).
Highlights
The current study aimed to evaluate the efficacy of intravitreal aflibercept injections as the primary treatment for subfoveal/juxtafoveal myopic choroidal neovascularization (CNV) by using optical coherence tomography (OCT)
The inclusion criteria included the following: treatment-naïve patients who were under follow-up for a minimum of 12 months; myopia with a spherical equivalent refractive error ≤ − 6 D or axial length ≥ 26.5 mm; active CNV secondary to pathologic myopia defined as presence of leakage from CNV seen by fluorescein angiography, and presence of intraretinal edema or subretinal fluid (SRF) or increase of central foveal thickness (CFT) seen by spectraldomain optical coherence tomography (SD-OCT); subfoveal/juxtafoveal CNV; and a best corrected visual acuity (BCVA) of 20/800 or greater
In the current study, most eyes showed improvement in vision and the burden of intravitreal therapies was found similar to the MYRROR study, which revealed that the patients with myopic CNV who underwent intravitreal aflibercept injection displayed significant improvements in visual and anatomic parameters over a time period of 48 weeks [18]
Summary
The current study aimed to evaluate the efficacy of intravitreal aflibercept injections as the primary treatment for subfoveal/juxtafoveal myopic choroidal neovascularization (CNV) by using optical coherence tomography (OCT). Pathologic myopia is defined as a refractive error of − 6.0 diopters or worse spherical equivalent, accompanied by the characteristic degenerative changes in the sclera, choroid, and retinal pigment epithelium, with severe visual impairment [1, 2]. Pathologic myopia has been reported to be the major cause of visual impairment or low vision in 12 to 27% of the Asian population [3,4,5]. The complications associated with pathologic myopia include posterior staphyloma, myopic maculopathy, myopic choroidal neovascularization (CNV) [1]. Myopic CNV is one of the most common complications associated with the aforementioned condition that may cause severe visual impairment [6]. It has been estimated that 5.2 to 11.3% of the patients with pathologic myopia will develop myopic CNV and the natural course and prognosis of subfoveal CNV are generally poor [3, 7,8,9]
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