Choroidal Neovascularization In Pathologic Myopia Research Articles

Factors associated with the recurrence of choroidal neovascularization in pathologic myopia.

PurposeTo investigate the factors associated with the recurrence of pathologic myopia choroidal neovascularization (PM-CNV).MethodsForty-eight eyes of 48 patients with PM-CNV treated with conbercept at least 6 months of follow-up were included. Appearance of ellipsoid zone (EZ) and retinal pigment epithelium (RPE) observed on optical coherence tomography (OCT). Hyperreflective foci (HRF) height measured on OCT. Observation of CNV shape on OCT-angiography (OCTA). PM-CNV area measured on OCTA. To observe relationship between these factors and best corrected visual acuity (BCVA) and PM-CNV recurrence.ResultsThe 48 patients (48 eyes) with PM-CNV were divided into two groups: yielding a group of 20 eyes with type 1 and a group of 28 eyes with type 2. The BCVA of type 1 was better than type 2 before and after treatment (P < 0.005). Smaller HRF height (P < 0.001) and CNV area (P < 0.001) for type 1 than type 2. The appearance of EZ and RPE were intact (P < 0.001). Spearman correlation analysis found that final BCVA was significantly associated with baseline BCVA, HRF height, and appearance of EZ (P < 0.05). Binary logistics regression analysis revealed that PM-CNV recurrence was significantly correlated not only HRF height and CNV area, but also with appearance of EZ, and RPE (P < 0.05).ConclusionPM-CNV had a higher recurrence ratio. Baseline BCVA and clinical features play an important role for vision prognosis. Factors associated with PM-CNV recurrence include HRF height, CNV area, and changes in EZ and RPE structure.

Порівняльне дослідження інтравітреального введення ранібізумаба та афліберсепта у пацієнтів з субретинальною неоваскулярною мембраною при високій ускладненій короткозорості

Порівняльне дослідження інтравітреального введення ранібізумаба та афліберсепта у пацієнтів з субретинальною неоваскулярною мембраною при високій ускладненій короткозорості

Reduced-fluence verteporfin photodynamic therapy plus ranibizumab for choroidal neovascularization in pathologic myopia.

To demonstrate the efficacy of intravitreal ranibizumab (IVR) in combination with reduced-fluence photodynamic therapy (RF-PDT) in patients with choroidal neovascularization (CNV) secondary to pathologic myopia. Sixty patients affected by myopic CNV (mCNV) were randomized to receive either ranibizumab 0.5mg monotherapy (RM; n = 20), standard fluence PDT (SF-PDT, n = 20) or RF-PDT combination therapy (n = 20). Subsequently, IVR was injected as needed. All patients were evaluated for 48weeks. Mean BCVA change at 48weeks was + 0.2 and +15 letters with SF or RFPDT plus ranibizumab, respectively, compared with +16.8 letters with RM. At 48weeks, mean central foveal thickness (CFT) decrease from baseline was 58 ± 15μm, 91.4 ± 43.8μm, and 85 ± 41.5μm for the verteporfin SF, RF and RM groups, respectively. Macular sensitivity improvement was + 0.4db, + 1.9dB and + 2.7dB for the verteporfin SF, RF and RM groups, respectively. Ranibizumab monotherapy or combined with RF-PDT improved BCVA and macular sensitivity in patients affected by mCNV, whereas CFT results were reduced. SF-PDT combination regimen mostly stabilized vision at 48weeks. Among all groups, the RF-PDT seemed to reduce the number of ranibizumab retreatments.

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

Pathological myopia (PM) or high myopia is defined as excessive short-sightedness (more than -6 dioptres) caused by a strong dilation of the bulbus oculi, that can induce the development of new and unstable vessel structures [choroidal neovascularisation (CNV)]. Since there are only limited epidemiological data available on PM, this health services research study was conducted. A health services survey with ophthalmologists throughout Germany was undertaken. Physicians were asked to complete a 51-item questionnaire on CNV in PM as well as on its early stages in their daily practice, diagnosis, control and treatment, patient numbers and evaluation of health care situation. Statistical analyses were entirely descriptive. Of 7,500 ophthalmologists, a representative sample of 800 was randomly selected; 340 physicians took part. The mean prevalence rates/year/practice were 1,765.5 ± 1,218.1 with myopia, 230.7 ± 278.6 patients with high myopia, subdivided into 129.3 ± 242.8 patients with PM without macular degeneration (MD), 39.6 ± 64.8 patients with PM and MD, and 13.3 ± 30.3 patients with PM and CNV. Data on diagnosis and control show a lack of clearly defined standardisation. With regard to treatment of CNV in PM the data show the current discrepancy of guideline recommendations and approved treatment options. The prevalence and incidence data collected in this study vary considerably between physicians. This may be explained by the various grades of specialisation as well as to possibly existing uncertainties regarding the definition and nomenclature of PM/high myopia and their different stages of the disease that should be harmonised. A generally accepted definition of severity grades, recommendations on diagnosis as well as detailed information and continuous training programmes on this disease is necessary.

Anti-vascular endothelial growth factor: the future treatment of choroidal neovascularization in pathologic myopia?

Anti-vascular endothelial growth factor: the future treatment of choroidal neovascularization in pathologic myopia?

Surgical removal of subfoveal choroidal neovascularization in pathologic myopia: a 12-year follow-up study

The purpose of this study was to review the 12-year visual outcomes of patients who underwent surgical removal for subfoveal choroidal neovascularization (CNV) attributable to pathologic myopia. This retrospective study included 14 patients, with a mean age of 45.8years, high myopia (>6D) and classic subfoveal CNV. They were treated with pars plana vitrectomy and surgical removal of CNV. All patients were followed up every 3months for 2years, with visual acuity (VA), fundus examination, and fluorescein angiography and then every year for 5years. Ten patients underwent a final visit with VA and fundus examination after a minimum 12-year follow-up. The main outcome measurement was VA and the secondary outcome measurement was the lesion size. After 12years of follow-up, the mean VA did not significantly change over time, with a mean gain of 0.22 logMAR at 1year, and 0.18, 0.12 and 0.05 at 2, 5 and 12years, respectively. The anatomical evolution was characterized by a significant enlargement of the lesion size at 5years. This study showed that final VA after surgical treatment with 12years of follow-up was poor, due to the significant CNV scar enlargement over time. These results should prompt a prospective randomized study of other medical treatments, particularly anti-vascular endothelial growth factor therapy.

Long-term results of intravitreal bevacizumab for choroidal neovascularisation in pathological myopia

AimTo evaluate the long-term results and prognostic factors of intravitreal bevacizumab (IVB) for myopic choroidal neovascularisation (mCNV).MethodsThirty-two eyes of 30 patients with mCNV were included in a prospective case series....

Characteristics of Periconus Choroidal Neovascularization in Pathologic Myopia

To examine the clinical characteristics of periconus choroidal neovascularizations (CNVs) in eyes with pathologic myopia. Retrospective observational case series. We reviewed the medical records of 260 eyes of 254 patients with a myopic CNV and selected those with a periconus CNV. A periconus CNV was defined as a CNV that is located next to a myopic conus. To differentiate a periconus CNV from a subfoveal CNV that has expanded to the edge of the disc, eyes whose CNV involved the fovea were excluded. The data of the eyes with a subfoveal CNV were used for comparison. Eleven eyes (4.2%) of 11 patients had a periconus CNV. These CNVs had a triangular or oval shape whose base was directed toward the myopic conus. The eyes with a periconus CNV had a significantly larger myopic conus than eyes with a subfoveal myopic CNV. The degree of myopia and axial length were not significantly associated with the incidence of periconus CNV. In 5 of the 11patients, the periconus CNV had a spontaneous regression without treatment, and none had a recurrence. The other 6 patients received treatment and obtained an angiographic closure after a single treatment. A chorioretinal atrophy (ChRA) developed in 3 eyes, and the ChRA enlarged over the fovea in 2 of these eyes, which led to a significant decrease of vision. A periconus CNV is rare (4.2%) among the eyes with a myopic CNV and is more likely to develop in eyes with a large myopic conus. The absence of a significant association between the degree of myopia and incidence of periconus CNV suggests that the morphologic characteristics of the eye are not the causes of the periconus CNV. Although an angiographic closure can be easily attained with or without the treatment, the later development and progression of ChRA can impair vision.

Ocular Risk Factors for Choroidal Neovascularization in Pathologic Myopia

PURPOSE. To identify the risk factors for development of myopic choroidal neovascularization (mCNV), a major cause of visual impairment. METHODS. Enrolled in the study were 23 consecutive patients with bilateral high myopia (axial length, > or =26.5 mm or refractive error, < or =8 D) and unilateral newly developed mCNV who presented to the Myopia Clinic, Osaka University Hospital. Spectral-domain optical coherence tomography (SD-OCT) showed that the fellow eyes had a normal macula. The parameters in the affected and fellow eyes were compared between the individual patients, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), refractive error, axial length, choroidal thickness (CT) (subfoveal, 1.5 mm superiorly and inferiorly), posterior staphyloma height 3 mm from the fovea, length of retinal pigment epithelium (RPE) curvature within 6 mm measured on SD-OCT images, and choroidal degeneration and lacquer crack formation, graded according to a published RESULTS. The IOP, axial length, refractive error, and chorioretinal degeneration did not differ significantly. Affected eyes had a significantly higher lacquer crack grade (P < 0.05). The superior CT was not significantly different; the subfoveal and inferior CTs were significantly lower in the affected eyes (P < 0.05 and P < 0.001, respectively). The absolute value of the nasal posterior staphyloma height from the fovea was significantly greater in the affected eyes (P < 0.05), and the affected eyes had a significantly (P < 0.05) longer RPE curvature. CONCLUSIONS. Choroidal thinning resulting from increased RPE/choroid curvature is a risk factor for unilateral mCNV.

Choroidal Neovascularization in Pathologic Myopia: Intravitreal Ranibizumab Versus Bevacizumab—A Randomized Controlled Trial

To compare the short-term efficacy and safety of intravitreal ranibizumab versus bevacizumab in treating myopic choroidal neovascularization (CNV). Prospective, comparative, randomized, interventional study. Thirty-two eyes from 32 patients with myopic CNV were consecutively enrolled and randomly treated, in a 1:1 ratio, with intravitreal ranibizumab (0.5 mg) or bevacizumab (1.25 mg) as needed, after the first injection. ETDRS best-corrected visual acuity (BCVA), foveal center thickness (FCT) on optical coherence tomography (OCT), and fluorescein angiographic findings were examined before and after treatment. Patients were followed up for 6 months. No statistically significant difference in the BCVA improvement, as well as in the FCT reduction, was found between groups during follow-up (P value at 1, 3, 6 months > .05). Complete resolution of fluorescein leakage was observed in all 16 bevacizumab-treated eyes and in 15 out of 16 (93.7%) ranibizumab-treated eyes. No ocular or systemic adverse effects from treatment were encountered. This randomized clinical study cannot determine a statistically significant difference in anti-VEGF treatment effect between ranibizumab and bevacizumab for the treatment of CNV secondary to pathologic myopia. A larger study is required to determine the relative efficacy and duration of action of these drugs.

Impact of Coagulation-Balance Gene Predictors on Efficacy of Photodynamic Therapy for Choroidal Neovascularization in Pathologic Myopia

To investigate whether different coagulation-balance genetic backgrounds might explain the variable clinical outcomes detected, after a single photodynamic therapy with verteporfin (PDT-V), in Caucasian patients with subfoveal choroidal neovascularization (CNV) secondary to pathologic myopia (PM). Retrospective, consecutive, nonrandomized, interventional cases series. Two hundred thirty-four patients exclusively treated with standardized PDT-V for the presence of PM-related classic CNV. The enrolled patients were subdivided as responders or nonresponders based on CNV responsiveness to the first PDT-V over a 3-month period. Three common gene polymorphisms, factor XIII-A G185T, methylenetetrahydrofolate reductase C677T, and methionine synthase reductase A66G, were genotyped by polymerase chain reaction in each patient. The measures of CNV responsiveness to PDT-V were the changes, respect to baseline, of fluorescein angiography CNV leakage, greatest linear dimension, and area of the lesion. Logistic regression analyses were performed to explore the predictive role of phenotypic (patient's age, baseline visual acuity, and baseline CNV area) and genotypic (all the mentioned mutations) variables regarding PDT-V efficacy. Responders to PDT-V were overrepresented within carriers of methylenetetrahydrofolate reductase 677 T-allele (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.8-5.4; P = 0.001) and, to a minor extent, among patients with better visual acuity at baseline (OR, 11.8; 95% CI, 1.6-88.0; P = 0.02). However, predictors of PDT-V lack of efficacy were patient's age (OR, 0.73; 95% CI, 0.62-0.86; P = 0.01) and, especially, factor XIII-A 185 GT/TT genotypes (OR, 0.19; 95% CI, 0.11-0.35; P = 0.0001). All the other considered predictive factors did not significantly influence the CNV responsiveness to PDT-V. These findings document the presence of pharmacogenetic correlations between common coagulation-balance gene polymorphisms and different CNV responsiveness to PDT-V in Caucasian patients with neovascular PM.

Low-fluence-rate photodynamic therapy to treat subfoveal choroidal neovascularization in pathological myopia. A study of efficacy and safety

To evaluate the efficacy and safety of low-fluence-rate photodynamic therapy (LFPDT) to treat choroidal neovascularisation (CNV) secondary to pathological myopia (PM). Twenty-five eyes with CNV in PM underwent LFPDT, with a standard dose of verteporfin and timing but adopting fluence and irradiance rates reduced to 25 mJ/cm2 and 300 mW/cm2, respectively. Best corrected visual acuity (BCVA) was measured and biomicroscopy and fluorescein angiography (FA) were evaluated. Particular attention was paid to choroidal hypoperfusion, and to changes (depigmentation/atrophy) at the RPE level in areas exposed to laser light. After a mean follow-up of 13.4+/-2.46 months (range: 12-21), and 1.37+/-0.66 treatments (range: 1-3), BCVA was stable in 29 (91%) eyes. Two (6%) patients gained more than three lines and one (3%) eye lost more than three lines. Mean greatest linear dimension did not change significantly (p=0.08) at the end of follow-up. RPE depigmentation was present in six eyes (18%) and no patient showed RPE atrophy. LFPDT is effective and safe for CNV secondary to PM treatment, stabilizing visual acuity and lesion size and determining only mild RPE changes. Further controlled studies are needed to demonstrate the long-term efficacy and safety of this treatment option.

Fundus autofluorescence in subfoveal choroidal neovascularisation secondary to Pathological Myopia

Aim:To describe the fundus autofluorescence (FAF) characteristics of choroidal neovascularisation (CNV) associated with pathological myopia (PM), and their modification after photodynamic therapy (PDT).Design:Open-label, prospective, interventional case series.Methods:Forty-two patients affected by...

Intravitreal Bevacizumab Treatment for Choroidal Neovascularization in Pathologic Myopia: 12-month Results

Intravitreal Bevacizumab Treatment for Choroidal Neovascularization in Pathologic Myopia: 12-month Results

Intravitreal Bevacizumab Treatment for Choroidal Neovascularization in Pathologic Myopia: 12-month Results

To evaluate the short-term efficacy and safety of intravitreal bevacizumab for the treatment of myopic choroidal neovascularization (CNV). Prospective, nonrandomized, interventional case series. Twenty eyes from 20 patients with CNV secondary to pathologic myopia participated in this prospective nonrandomized interventional case series. All patients were scheduled for three monthly intravitreal bevacizumab 1.25 mg injections. Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), foveal center thickness (FCT) on optical coherence tomography (OCT), and fluorescein angiographic findings were examined before and after treatment. Patients were followed up for 12 months. The mean BCVA (+/- standard deviation [SD]) at baseline was 24.8 (+/- 11.86) letters (Snellen equivalent: 20/80). At 12 months after treatment, the mean BCVA (+/- SD) improved significantly (P = .000001) to 43 (+/- 12.38) letters (Snellen equivalent: 20/35). At 12 month follow-up, BCVA improved 10 letters or more in 18 (90%) out of 20 treated eyes and improved 15 letters or more in 14 (70%) out of 20 treated eyes. No treated eyes experienced a worsening of BCVA from baseline. The mean FCT (+/- SD) at baseline was 223 (+/- 47.43) microns. At 12 months after treatment, the mean FCT (+/- SD) reduced to 206 (+/- 50.87) microns. This reduction in FCT after treatment was not statistically significant (P = .11). At 12 months follow-up, absence of fluorescein leakage from the CNV was demonstrated in 19 (95%) out of 20 treated eyes and persistent leakage in one eye (5%). None of the 19 eyes that had CNV closure experienced recurrence at 12-month follow-up. No ocular or systemic adverse effects from treatment were encountered. These results of intravitreal bevacizumab in myopic CNV are very promising with no apparent short-term safety concerns. At 12 months, treated eyes had a significant improvement in visual acuity (VA). OCT findings, as well, showed a trend consistent with the beneficial changes observed for VA. Treatment resulted in complete absence of angiographic leakage in 95% of eyes. Further studies will be needed to better determine long-term efficacy and safety.

Retinal Pigment Epithelial Marginal Retraction after Photodynamic Therapy for Choroidal Neovascularization in Pathologic Myopia

To report the incidence of retinal pigment epithelial (RPE) marginal retraction after verteporfin photodynamic therapy (PDT) for subfoveal choroidal neovascularization (CNV) in pathologic myopia (PM). Retrospective review of 236 patients treated with PDT for subfoveal CNV due to PM. RPE marginal retraction was found in 3 eyes (1.3%), and a decrease of a mean of five lines of vision was reported to occur 10-15 days after treatment. At the end of followup two eyes lost three lines and one six lines from baseline. RPE marginal retraction as an early complication of PDT for subfoveal CNV secondary to PM is rare. The low incidence of this adverse event, however, should not preclude recommendations for PDT in myopic eyes that could benefit from this treatment modality.

OCT-Guided Photodynamic Therapy for Angiographic Occult CNV in Pathologic Myopia

Pathologic myopia (PM) is frequently complicated by choroidal neovascularization (CNV). Diagnosis is mainly clinical and angiographic but in recent years optical coherence tomography (OCT) has been noted to add important information. The authors report on the successfully OCT-guided photodynamic therapy (PDT) of an angiographic occult CNV complicating PM. Observational case report. Fluorescein angiography with a confocal SLO (HRA, Heidelberg Engineering, Germany) and OCT Stratus (Carl Zeiss Meditec, Inc.) imaging were used for diagnosis and monitoring of the CNV. Standard PDT was performed. A highly myopic 17-year-old girl complained of a drop in visual acuity (VA) in left eye (LE), dating back a few weeks. Her best-corrected (BC) VA was 20/40 in the LE, with some metamorphopsia. No hemorrhage or evident signs of CNV were visible either at fundus or at dynamic fluorescein angiography. OCT scans indicated a slight elevation of the RPE-choriocapillary complex with rarefaction of neuroretinal tissue that has been interpreted as CNV. PDT was then performed. LE BCVA had improved to 20/25, metamorphopsias disappeared, and at OCT examination no retinal morphologic modification was evident. Nine months later, BCVA and ophthalmoscopy are still stable. In this case, OCT was the fundamental tool for the correct diagnosis and posttherapymonitoring of CNV-complicated PM. The CNV, not clearly detectable using angiographic imaging, was treated with PDT, and results in terms of VA and anatomic resolution were good.

Circulating hematopoietic stem cells in patients with choroidal neovascularization secondary to pathologic myopia

Emerging evidences suggest that circulating hematopoietic stem cells (HSCs) affect the pathogenesis of choroidal neovascularization (CNV), however, the roles of HSCs in CNV remain unclear in human population. The current study was designed to investigate the role of HSCs in the pathogenesis of CNV secondary to pathologic myopia (PM). We clinically documented 78 patients with CNV in PM, and 35 of 78 patients and 28 age-matched controls were experimentally analysed. Functional analyses of HSCs were performed using an ex vivo culture system. We disclosed colony-forming units of endothelial cell (CFU-EC) were markedly lower in patients with bilateral CNV compared to those with unilateral CNV (13.8+/-3.7 vs 45.9+/-7.8, P<0.001). Systemic characteristics between both groups showed no significant difference. To identify local ocular factors that may affect the occurrence of CNV, clinical parameters were compared with the following groups in all enrolled subjects: eyes with CNV vs without CNV in unilateral affected patients, and primary affected eyes vs secondary affected eyes in patients with bilateral CNV. However, no statistically significant factors were identified in any of the groups. Circulating HSCs may play a role in the bilateral involvement of CNV in PM patients as one of the systemic factors. Further prospective and longitudinal studies are required.

Choroidal Neovascularization in Pathologic Myopia: Recent Developments in Diagnosis and Treatment

Choroidal neovascularization is a common cause of vision loss in patients with pathologic myopia, often resulting in irreversible central vision loss. This is particularly important because choroidal neovascularization secondary to pathologic myopia affects many people of working age. Patients may be limited in the types of tasks they can perform effectively or may even have to give up work; thus, in addition to the emotional strain, the vision loss caused by choroidal neovascularization can have a severe impact on career expectations and financial status. This is an important issue for younger patients who may be supporting themselves and their families. In this article, the epidemiology and risk factors of pathologic myopia are reviewed, as well as the pathologic mechanisms, clinical features, and diagnostic tests for choroidal neovascularization secondary to pathologic myopia. The focus of the article is on treatment options, which until recently were limited. The evidence for the beneficial effects of laser photocoagulation, photodynamic therapy with verteporfin, surgery, and other techniques in the treatment of choroidal neovascularization secondary to pathologic myopia will be evaluated.

Two years follow-up outcome of verteporfin therapy for subfoveal choroidal neovascularization in pathologic myopia in Indian eyes

In India, refractive errors are a major cause of treatable blindness. Population surveys in southern India have shown prevalence of high myopia to be 4.32-4.54%. Photodynamic therapy (PDT) for choroidal neovascularization (CNV) caused by pathologic myopia is beneficial. To report the 24 months outcome of PDT with verteporfin for subfoveal CNV caused by pathologic myopia in Indian eyes. Prospective case series. Review of prospectively collected data of Indian patients with pathologic myopia and subfoveal CNV treated with verteporfin therapy between 2001 and 2005 using standard regimen for PDT. Wilcoxon signed rank test was used to see the difference in the mean letter acuity at intervals compared to baseline. Kaplan Meier Survival analysis was done to estimate the success rate of verteporfin therapy for CNV caused by pathologic myopia. Fifteen patients (15 eyes) treated with standard fluence PDT and who had completed 24 months follow-up were analyzed. The mean spherical equivalent was -13.36 +/- 5.88 diopter. Five out of 15 eyes in six months, three out of 15 eyes at 12 months and four eyes out of 15 at 24 months had improved vision by > 10 letters. The mean number of treatment session was 2.2 in two years. PDT with verteporfin for subfoveal CNV caused by pathologic myopia in Indian eyes is effective.