Abstract
The aim of the study was to assess retinal vascular changes using optical coherence tomography angiography (OCTA) and aqueous humour changes of vascular endothelial growth factor (VEGF) and placental growth factor (PIGF) levels in treatment-naïve myopic choroidal neovascularization (mCNV) after aflibercept intravitreal injection. To explore the correlation between clinical and laboratory parameters. Fifteen eyes of 15 patients with treatment-naïve mCNV underwent 2 intravitreal injections of aflibercept. Main outcome measures were best corrected visual acuity (BCVA), central retinal thickness (CRT) and external limiting membrane (ELM) visualization at OCT, lesion area and leakage at fluorescein angiography (FA), OCTA flow area and selected area at baseline and after the injections. Analysis of VEGF and PlGF in the aqueous humor was performed before each injection in cases and prior to cataract surgery on 10 patients as included as controls. Median BCVA increased from 0.6 to 0.3 logMAR (p < 0.001); CRT decreased from 387.5 to 267 micron (p < 0.001); FA area from 0.8 to 0.5 mm2 and OCTA area from 0.9 to 0.5 mm2 (p = 0.005). PIGF values changed from 1.8 to 1.4 pg/ml (p = 0.019) and VEGF values from 3.4 to 0.5 pg/ml (p = 0.008). A significant correlation was found after treatment between PIGF levels and BCVA (rho = 0.006) and VEGF levels and BCVA (rho = 0.018); between PlGF and CRT (rho = 0.020), PlGF and ELM visualization (rho = 0.002) and PlGF and FA leakage (rho < 0.001). Our results showed a significant reduction of mCNV area after aflibercept in both FA and OCTA measurements; an improvement of BCVA, and a reduction of VEGF and PIGF levels related to inactivity of the disease.
Highlights
Pathological myopia (PM), known as degenerative myopia, is a condition in which individuals have an axial length >26 mm corresponding to a refractive error of at least −6.0 diopters (D)[1]
Fifteen eyes of 15 patients (6 males and 9 females) with PM complicated by treatment-naïve myopic choroidal neovascularization (mCNV) and 15 eyes of 15 healthy age-matched subjects (5 males and 10 females) were included in this study (Table 1)
The gold standard treatment decision method is still based on fluorescein angiography (FA) late frames or on Spectral domain optical coherence tomography (SD-OCT) features, a novel dyeless technique for producing retinal imaging was widely speculated[2,3,5,6]
Summary
Pathological myopia (PM), known as degenerative myopia, is a condition in which individuals have an axial length >26 mm corresponding to a refractive error of at least −6.0 diopters (D)[1]. Spectral domain optical coherence tomography (SD-OCT) showed great sensitivity (about 97%) for detecting mCNV’s activity[4]. The OCTA examination demonstrated high sensitivity and specificity to detect mCNV6. Previous therapies such as laser photocoagulation for extra/juxtafoveal CNV, and photodynamic therapy with verteporfin for subfoveal CNV have shown limited outcomes[7,8]. Anti-vascular endothelial growth factor (anti-VEGF) intravitreal injection has been recommended as first-line therapy for CNV-related PM, showing efficacy and safety as treatment strategy[9]. Morphological changes of mCNV have been described after anti-VEGF drugs injections by means of multimodal imaging and using OCTA10–12. In addition variations of aqueous humor cytokines after anti-VEGF drug treatment for mCNV have been described in several studies[10,13]. The recent introduction of aflibercept (Eylea; Regeneron Pharmaceuticals, Tarrytown, NY, USA) for the treatment of mCNV provides an alternative mechanism of VEGF blockade by binding all isoform of VEGF-A, VEGF-B, and placental growth factor (PIGF)
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