Juxtafoveal Choroidal Neovascularization Research Articles

Comparison of the efficacy and safety of SCD411 and reference aflibercept in patients with neovascular age-related macular degeneration

To compare the efficacy and safety of the proposed aflibercept biosimilar SCD411 and reference aflibercept in patients with neovascular age-related macular degeneration, this randomized, double-masked, parallel-group, multicenter study was conducted in 14 countries from 13 August 2020 to 8 September 2022. Patients with neovascular age-related macular degeneration. With subfoveal, juxtafoveal, or extrafoveal choroidal neovascularization were aged 50 years or older. Intravitreal injection of SCD411 or aflibercept (2.0 mg) were administered every 4 weeks for the first three injections and every 8 weeks until week 48. The primary efficacy endpoint was the change in best-corrected visual acuity from baseline to week 8 with an adjusted equivalence margin of ± 3.0 letters. Patients were randomly assigned to receive either SCD411 (n = 288) or reference aflibercept (n = 288). A total of 566 participants (98.3%) completed week 8 of the study. The least-squares mean difference of change in best-corrected visual acuity from baseline to week 8 (SCD411—aflibercept) was − 0.4 letters (90% confidence interval = − 1.6 to 0.9). The incidence of ocular (69 of 287 [24.0%] vs. 71 of 286 [24.8%]) and serious ocular (5 of 287 [1.7%] vs. 3 of 286 [1.0%]) treatment-emergent adverse effects were similar between the SCD411 and aflibercept groups. Immunogenicity analysis revealed a low incidence of neutralizing antibody formation in both groups. In conclusion, SCD411 has equivalent efficacy compared with reference aflibercept in patients with neovascular age-related macular degeneration and has a comparable safety profile. The results support the potential use of SCD411 for the treatment of neovascular age-related macular degeneration.

Secukinumab Associated Choroidal Neovascularization

A previously healthy 38-year-old woman with non-radiographic spondyloarthritis (nrSpA) developed juxta-foveal Choroidal Neovascularization (CNV) in the right eye three months after starting treatment with the anti-IL-17A inhibitor secukinumab. As there was no sign of ocular inflammation, no known association with CNV and this rheumatic disease, and other etiologic etiologies were excluded, this biologic agent was the suspected cause. Drug discontinuation and treatment with bevacizumab resulted in full suppression of the neovascular activity. IL-17 has a purported etiologic role in ocular neovascular diseases. The onset of this process in a patient receiving anti-IL-17 therapy suggests a possible causative role requiring further clarification.

Papilledema associated unilateral juxtafoveal choroidal neovascularization in a patient of intracranial chondrosarcoma

Skull base chondrosarcomas are rare intracranial neoplasms. Although peripapillary choroidal neovascularization (CNV) has infrequently been noted in papilledema secondary to other pathologies, juxtafoveal CNV following intracranial chondrosarcomas have never been reported earlier. We report a case of a 50-year-old lady with operated intracranial chondrosarcoma who presented with progressive diminution of vision in the right eye. Detailed ophthalmic evaluation and ancillary investigations confirmed the diagnosis of papilledema associated juxtafoveal CNV in the right eye, and she received two intravitreal bevacizumab injections with guarded outcome. We have also described the probable differentials of the current case and highlighted the need for a high index of suspicion among neurologists as well as ophthalmologists for this rare but vision-threatening complication.

Long-term follow-up of management of choroidal neovascularisation secondary to angioid streaks with intravitreal anti-vascular endothelial growth factor

To assess the short-term and long-term visual outcomes in patients with choroidal neovascularisation (CNV) secondary to angioid streaks treated with intravitreal anti-vascular endothelial growth factor (VEGF). Retrospective, single-centre study. Overall 66 eyes of 52 patients were analysed. Follow-up ranged from 1 to 10 years. BCVA was 62 ETDRS letters at baseline, 68 letters at 1 year, 60 ETDRS letters at 5 years and 58 letters at 7 years. At 2 years patients gained 5.7 ETDRS letters from baseline but this gain was lost at 5 years. At 5 years there was an average loss of ETDRS letters from baseline of 3.3 letters. Sub-group analysis of subfoveal CNV showed worse outcome compared with eyes with extrafoveal and juxtafoveal CNV. In subfoveal CNV, BCVA was 53 ETDRS letters at 1 year (p < 0.0001) and 39 ETDRS at 5 years (p = 0.0005). Anti-VEGF therapy is effective at stabilising visual acuity in patients with choroidal neovascularisation secondary to angiod streaks, however there is a gradual decline in visual acuity observed with 5-10 years of follow-up. Furthermore, subfoveal CNV have worse visual outcome compared with extrafoveal and juxtafoveal CNV.

An efficacy analysis of anti-vascular endothelial growth factor therapy for choroidal neovascularization secondary to multifocal choroiditis and comparison with wet age-related macular degeneration.

To evaluate the effect of anti-vascular endothelial growth factor (VEGF) on juxtafoveal choroidal neovascularization (CNV) secondary to multifocal choroiditis (MFC) and wet age-related macular degeneration (AMD). In this retrospective, comparative study, 20 unique eyes with CNV were divided into two groups: 10 patients affected by MFC and 10 patients diagnosed with wet AMD. They all received local intravitreal (IVT) injections of ranibizumab, with 6 months of follow-up. Retreatment injections were performed based on findings suggestive of active neovascularization. Significant improvements were observed in the juxtafoveal CNV lesions, and average central macular thickness decreased in both groups following the anti-VEGF therapy (P<0.05). The average number of injections used in MFC patients was 1.6, while three injections on average were used in wet AMD patients (Z=-2.844, P=0.009). Best-corrected visual acuity was significantly improved in MFC patients after anti-VEGF therapy (P<0.05), and there was no significant difference in wet AMD patients between before anti-VEGF therapy and 6 months later (P>0.05). IVT ranibizumab resulted in good clinical outcomes for juxtafoveal CNV secondary to MFC and wet AMD, but the average number of injections used in MFC was fewer than that used in wet AMD over a 6-month observation period. Compared with the wet AMD group, visual acuity was obviously improved in the MFC group at 6 months.

Efficacy and safety of conbercept as a primary treatment for choroidal neovascularization secondary to punctate inner choroidopathy

BackgroundTo evaluate the efficacy and safety of intravitreal conbercept (KH902) as the primary treatment of choroidal neovascularization secondary to punctate inner choroidopathy.MethodsThis study was a retrospective, consecutive, observational case series. We reviewed medical records of 16 eyes (16 patients) with naive subfoveal or juxtafoveal choroidal neovascularization secondary to punctuate inner choroidopathy that were treated with intravitreal conbercept injections. All patients completed at least six months of follow-up. Best-corrected visual acuity (BCVA) was measured, and anatomical features were assessed with fluorescein angiography, indocyanine green angiography, and optical coherence tomography.ResultsAt the month-6 follow-up visit, best-corrected visual acuity improved from 0.70 ± 0.36 (with approximate Snellen equivalent of 20/100) to 0.44 ± 0.25 (20/50 in Snellen) logarithm of the minimum angle of resolution (logMAR) (P = 0.003). Mean improvement of vision was 2.6 lines, with 50% treated eyes (8 eyes of 16) showing an improvement of ≥3 lines and 62.5% (10 eyes of 16), obtaining an improvement of ≥2 lines; all 16 eyes had stable or improved vision. Mean central retinal thickness decreased from 294.94 ± 102.68 μm to 206.56 ± 61.71 μm (P = 0.005). Fifteen eyes (93.75%) showed absence of CNV leakage at the end of the study period. No conbercrept-related systemic or ocular adverse events were observed.ConclusionIntravitreal injection of conbercept significantly improved visual and anatomical outcomes in choroidal neovascularization secondary to punctate inner choroidopathy over a 6-month follow-up period.Trial registrationISRCTN85678307, retrospectively registered on May 11, 2017.

Efficacy of Anti-VEGF and Subtenon Injection of Triamcinolone Acetonide for Choroidal Neovascularization Associated with Multifocal Choroiditis

Purpose: To evaluate the short-term efficacy of intravitreal anti-VEGF (Lucentis) and sub-tenon injection of triamcinolone acetonide for choroidal neovascularization (CNV) associated with multifocal choroiditis (MC). Methods: Eight eyes of 8 patients treated with intravitreal anti-VEGF and posterior sub-tenon injection of Triamcinolone Acetonide (TA) for subfoveal or juxtafoveal CNV associated with MC were retrospectively reviewed. Best corrected visual acuity (BCVA), results of fundus fluorescein angiography (FFA)/indocyanine green angiography (ICGA), optical coherence tomography (OCT) at baseline and 3, 6 months after treatment were compared. Results: All of the 8 patients showed significant improvement in BCVA at 3 and 6 months after treatment (P < 0.05). FFA/ICGA showed decrease or cessation of inflammation in 8 patients (100%). 7 patients (87.5%) had no significant active leakage while 1 patient (12.5%) had persistent leakage from the neovascular lesion at 3-month follow up. 6 months after treatment, no recurrence of inflammation occurred and no active leakage in all 8 patients. OCT showed reduced CNV area and alleviated edema. There are no severe treatment-related side effects expect slight eye pain during infusion in one patient. Intraocular pressure was all normal in follow up. Conclusion: Although the follow-up time and the number of patients in this study were limited, the use of intravitreal anti-VEGF combined with sub-tenon injection of TA was associated with improvement of visual acuity in patients with CNV secondary to MC. Further studies including a greater number of patients with longer follow up time are needed.

ANTIANGIOGENICS IN CHOROIDAL NEOVASCULARIZATION ASSOCIATED WITH LASER IN CENTRAL SEROUS CHORIORETINOPATHY.

To report characteristics and treatment outcome of choroidal neovascularization (CNV) secondary to laser photocoagulation and photodynamic therapy (PDT) in central serous chorioretinopathy. Retrospective analysis of 12 eyes of 12 patients, who were diagnosed to have CNV secondary to laser photocoagulation or PDT for central serous chorioretinopathy. Collected data included demographic details, history of presenting illness, clinical examination details including visual acuity at presentation, and follow-up with imaging and treatment details. Main outcome measures were resolution of CNV activity at the last follow-up. Secondary outcomes included change in visual acuity at final follow-up from baseline, number of injections, treatment-free interval, and adverse events. This study included 12 eyes of CNV secondary to laser photocoagulation (8 eyes) and PDT (4 eyes). Mean age of study subjects was 47.6 ± 15.4 years (range 33-82) with 8 men and 4 women. Mean interval between laser photocoagulation/PDT and diagnosis of CNV was 23.9 ± 54.5 months. All subjects had unilateral CNV with classic CNV on fluorescein angiography. Eight eyes had extrafoveal CNV, and four eyes had juxtafoveal CNV. Baseline best-corrected visual acuity was 0.56 ± 0.51 (Snellen equivalent 20/60) logMAR, and final best-corrected visual acuity was 0.53 ± 0.51 (Snellen equivalent 20/60) logMAR with no significant difference (P = 0.84). All four eyes that presented with the CNV secondary to PDT group required additional PDT treatment because of poor response to antivascular endothelial growth factor therapy. At the last follow-up, only one patient in the laser group had active CNV; the remaining patients of both groups had scarred CNV. Mean follow-up duration was 22.4 ± 23.1 months. Mean number of injections was 3.16 ± 2.62. Longest treatment-free interval was 8.29 ± 11.4 months. Antivascular endothelial growth factor therapy appears to be safe and efficacious in CNVs secondary to laser photocoagulation and PDT. Choroidal neovascularizations secondary to PDT appear to be more resistant to antivascular endothelial growth factor therapy than those because of laser photocoagulation and required additional PDT.

Intravitreal Bevacizumab for Nonsubfoveal Choroidal Neovascularization Associated With Angioid Streaks: 3-Year Follow-up Study

To assess the effects of intravitreal bevacizumab injections in the treatment of nonsubfoveal choroidal neovascularization (CNV) associated with angioid streaks (AS) in a 3-year follow-up study. Noncomparative, interventional, prospective case series. Eighteen patients (18 eyes) with juxtafoveal/extrafoveal CNV secondary to AS were recruited. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) measurement on ETDRS chart, optical coherence tomography (OCT), and fluorescein angiography (FA). The protocol treatment included a first injection, followed by repeated injections on the basis of detection of new hemorrhage, any type of fluid on OCT, and/or presence of FA leakage. Primary outcome measures were final mean changes in BCVA and proportion of eyes with 10 ETDRS letters improvement. Secondary outcomes were mean changes of central macular thickness (CMT) and foveal involvement. After a mean BCVA stabilization over the first year, a statistically significant BCVA worsening was registered at the 24-month (72.8 ± 10.0 ETDRS letters, P= .03) and 36-month examinations (65.8 ± 15.0 ETDRS letters, P= .02) in comparison with the 1-year visual outcomes (80.1 ± 5.4 ETDRS letters); lastly, a substantial stabilization in the BCVA was observed at 36months in comparison with the baseline value (77.9 ± 10.0 ETDRS letters, P= .22). Two eyes (25%) with juxtafoveal CNV and no eye with extrafoveal CNV experienced a 10-letter improvement at the 3-year examination. Mean CMT at baseline was 220 ± 15μm and 235 ± 66μm at 36months (P= 1.00). During the first and second years of follow-up, 5 juxtafoveal CNVs and 3 extrafoveal CNVs showed foveal involvement. Intravitreal bevacizumab can be effective in the management of nonsubfoveal CNV secondary to AS, although monthly monitoring is required to control CNV recurrence or progression.

Macular Hole Retinal Detachment Following Surgical Removal of Myopic Choroidal Neovascularization: A Case Report

AIM: To report a case of Japanese woman who developed macular hole retinal detachment (MHRD) following surgical removal of myopic choroidal neovascularization (CNV). PATIENT: The best-corrected visual acuity (BCVA) was 20/200 with -17.0 diopters in her left eye. She was diagnosed with juxtafoveal CNV and subretinal hemorrhage secondary to myopia. She underwent surgical removal of the CNV. Postoperatively, the CNV was not detected. 2.5 years postoperatively, the BCVA was 20/16. At 6.5 years postoperatively, however the patient presented with worsening vision. The BCVA was 20/220. Funduscopic examination as well as optical coherence tomography (OCT) revealed retinal detachment involving the posterior pole with a macular hole. The patient underwent a vitrectomy without removal of the internal limiting membrane (ILM), and silicone oil tamponade. Finally, Silicone oil was removed. At the latest visit, a flattened macula with a closed macular hole was observed by OCT. The BCVA was 20/100. CONCLUSION: In this case, the reason for the development of MHRD without vitreous and spontaneous closure of the macular hole without vitreous or removal of the ILM is unknown. A higher index of suspicion of MHRD may be warranted for patients who complain of sudden vision loss after surgical treatment for myopic CNV.

FACTORS INFLUENCING NEED FOR RETREATMENT AND LONG-TERM VISUAL OUTCOME AFTER INTRAVITREAL BEVACIZUMAB FOR MYOPIC CHOROIDAL NEOVASCULARIZATION.

To evaluate the efficacy and the predictive factors associated with the need for retreatment and long-term visual outcome after intravitreal bevacizumab for myopic choroidal neovascularization (CNV). Retrospective cohort study of 93 eyes with subfoveal or juxtafoveal myopic CNV treated initially with either 3-monthly or single intravitreal bevacizumab injections followed by pro re nata retreatment. The efficacy was evaluated by the best-corrected visual acuity (BCVA) during follow-up visits. Backward stepwise multiple linear regression analyses were performed to evaluate the potential predictive factors on final BCVA, change in BCVA, and number of injections. Multiple logistic regression was performed to evaluate the potential predictive factors for retreatment. The mean follow-up duration was 25.12 ± 11.18 (SD) months. The mean logMAR BCVA at baseline was 0.72 ± 0.58 logMAR (20/100 Snellen equivalent) and was maintained at 0.39 ± 0.46 logMAR (20/50 Snellen equivalent) at the last follow-up (P < 0.001). The mean number of injections was 3.53 ± 1.70 (range, 3-10), and a total of 25 eyes (26.9%) received retreatment. Patients who received single loading injection had significantly lower mean total number of injections (1.50 ± 0.73 vs. 3.96 ± 1.53). Both subfoveal and juxtafoveal myopic CNV eyes had significant improvement in BCVA (0.28 ± 0.43 vs. 0.22 ± 0.32 [20/40 vs 20/30 Snellen equivalent], P = 0.506), and juxtafoveal myopic CNV eyes had significantly better BCVA at baseline and at the last follow-up than the subfoveal group. Treatment-naive eyes had significant improvement from baseline BCVA, and the amount of improvement was significantly more than those who received previous photodynamic therapy (0.31 ± 0.43 vs. 0.06 ± 0.11 [20/40 vs 20/25 Snellen equivalent], P < 0.001). Multivariate stepwise regression analysis showed that the baseline CNV size (P < 0.05), baseline BCVA (P < 0.001), and duration of symptoms (P < 0.05) were significant predictive factors for final BCVA, and BCVA improvement. Multiple logistic regression analysis identified that CNV size (P = 0.014) and follow-up duration (P = 0.017) were significant predictive factors for retreatment. No significant association was found for number of injections. Intravitreal bevacizumab seems to be an effective treatment for both subfoveal and juxtafoveal myopic CNV in the long term. Patients presented with shorter duration of symptoms and smaller CNV size before treatment as significant prognostic factors that predict better visual outcome. Eyes with longer follow-up duration and larger baseline CNV size may have higher risk for retreatment.

Choroidal Neovascularization Accompanied by Tractional Posterior Hyaloid Membrane Secondary to Candida Chorioretinitis

A 62-year-old-male presented at our clinic with decreased vision and metamorphopsia(OD) for several days. He had received an anti-fungal treatment two months before for the treatment of endogenous candida choroiditis (OU). Fluorescein angiography and optical coherence tomography revealed subfoveal, juxtafoveal choroidal neovascularization and tractionalposterior hyaloidmembrane (OD). Pars planavitrectomy and epiretinal membrane removal was done, and twointravitrealbevacizumabinjections were administered. His visual symptoms were not improved and chorioretinal scar and fibrotic change were detected at fovea.

Long-term variable outcome of myopic choroidal neovascularization treated with ranibizumab.

The purpose was to evaluate the long-term efficacy of ranibizumab for the treatment of myopic choroidal neovascularization (CNV) in a clinical setting. This was a retrospective, monocentric, noncomparative analysis of 51 eyes of 51 patients with naïve juxtafoveal or subfoveal myopic CNV treated with intravitreal ranibizumab (IVR) on a pro re nata basis for at least 24months. The patients' demographic data were recorded, including the best-corrected visual acuity (BCVA) measured with an ETDRS chart, location of the CNV, grade of myopic changes, central foveal thickness (CFT), and number of administered IVR. Outcome measures were to determine the changes in BCVA, identify the factors influencing the visual outcome, compare the best visual gain obtained for each treated eye with the final visual gain, and identify the cause of the relative decline in the visual acuity, when present. BCVA improved from 58.7±19.0 letters at baseline to 66.3±16.2 letters at the final visit (P=0.001; mean visual gain: +7.6±15.6 letters). Multivariate analysis did not identify any correlation between the visual gain and age, sex, grade of myopic fundus changes, CNV location, or initial protocol. The mean IVR number was 3.5±2.8 injections (range 1-12; median 3) for a mean follow-up of 39.3±11.3months (range 24-69). Twenty-one eyes experienced a relative decline in BCVA during the follow-up, which was attributable in 16 cases to myopic atrophic changes. Intravitreal ranibizumab resulted in long-term efficacy in the treatment of myopic CNV. However, some eyes may present a long-term relative decline in their initial visual gain.

Intravitreal ranibizumab for the treatment of pathological myopia associated with choroidal neovascularization in Chinese patients

Background Pathological myopia (PM) is the leading cause for choroidal neovascularization (CNV) in people below 50 years of age, the anti-vascular endothlial growth factor (VEGF) medicine is now available to treat CNV secondary to PM. This study aimed to observe the efficacy of intravitreal ranibizumab for PM associated with subfoveal or juxtafoveal CNV in Chinese patients. Methods Fifty-four eyes of 52 consecutive patients were included, they treated with intravitreal ranibizumab 0.5 mg for PM associated with CNV. The best corrected visual acuity (BCVA) of Snellen chart, letters of ETDRS chart, retinal thickness, leakage of CNV lesion, and complications with surgery were analyzed pre- and post-treatment. Eligibility criteria included diopter ≥-8.0 D or eye axis ≥28 mm with fundus changes of PM (lacquer crack, optic disc atrophy, chorioretinal atrophy, posterior scleral staphyloma); CNV secondary to PM; subfoveal or juxtafoveal CNV. Results For 54 affected eyes of 52 consecutive patients, the average BCVA of Snellen chart and letters of ETDRS chart were 0.29 and 30.4, respectively; fundus fluorescein angiography (FFA)/indocyanine green angiography (ICGA) showed CNV leakage, and average retinal thickness on optical coherence tomography (OCT) was 267.2 μm before treatment. Injections of ranibizumab ranged from 1 to 4 (mean 2.2). Follow-up time varied from 12 to 36 months (mean 31.9 months). At the last visit, the BCVA of Snellen chart was increased by three lines (mean 0.65) (P &lt;0.01); the letters of ETDRS chart were increased to 17.0 letters (mean 47.4, P &lt;0.01); the visual acuity increased more than 15 letters in 30 eyes (55.5%), decreased in 1 eye (1.9%); the retinal thickness on OCT images was decreased by 17.0 μm (mean 250.2 μm) (P=0.082); no active leakage from the CNV lesion occurred in 18 eyes (33.3%), reduced leakage in 30 eyes (55.6%), and no change in 6 eyes (11.1%) as shown by FFA/ICGA. Increased retinoschisis was observed in one eye after the second injection. Conclusions Intravitreal ranibizumab for neovascular PM was well tolerated in Chinese patients, with functional and anatomic improvements in a short-term study, while a long-term study is still needed.

Photodynamic Therapy in Subfoveal and Juxtafoveal Myopic Choroidal Neovascularization: A 10-year Retrospective Analysis

The aim of this study was to evaluate and compare the effects of photodynamic therapy (PDT) in eyes with subfoveal and juxtafoveal choroidal neovascularization (CNV) secondary to pathological myopia. The study was a single-center, 10-year analysis on 19 eyes. Patients underwent best-corrected visual acuity (BCVA) measurement, slit-lamp examination, ophthalmoscopy and fluorescein angiography. Eyes with subfoveal CNV (7 eyes, 37%) progressively worsened during the 10-year follow-up from 0.68 ± 0.26 to 0.80 ± 0.47 logMAR, while in the eyes with juxtafoveal CNV (12 eyes, 63%) BCVA improved from 0.59 ± 0.42 to 0.33 ± 0.27 logMAR. Prevalence and extension of chorioretinal atrophy (CRA) were greater in eyes with subfoveal compared with juxtafoveal CNV (84 vs. 66%, respectively) and enlargement (10.05 ± 6.7 vs. 3.53 ± 4.7 mm², respectively). Our results confirm the limited long-term effectiveness of PDT in myopic subfoveal CNV. Satisfactory results can be achieved in juxtafoveal CNV with a better visual outcome and a minor CRA extension.

Intravitreal bevacizumab for choroidal neovascularisation in serpiginous choroiditis

PurposeTo assess the effects of intravitreal bevacizumab (IVB) in the treatment of choroidal neovascularisation (CNV) secondary to serpiginous choroiditis (SC).DesignNon-randomised, interventional case series.ParticipantsSeven patients (seven eyes) affected by juxtafoveal CNV...

Intravitreal Bevacizumab Injection for the Treatment of Choroidal Neovascularization Secondary to Candida Chorioretinitis

Purpose: To report a case of choroidal neovascularization (CNV) secondary to candida chorioretinitis initially treated with an intravitreal bevacizumab injection. Case summary: A 50-year-old female presented at our clinic with decreased vision and metamorphopsia in her left eye of 5 days duration. She received an anti-fungal treatment 2 months prior due to the presence of endogenous candida choroiditis in both eyes. Fluorescein angiography and optical coherence tomography (OCT) revealed juxtafoveal CNV in her left eye. Three monthly intravitreal injections of bevacizumab were administered as the initial loading dosage. Her visual symptoms improved and CNV regression was observed on OCT. No recurrence or complications were observed during the 6 month follow-up. Conclusions: Based on the present study results we suggest that intravitreal bevacizumab injection can be used to effectively treat CNV and improve visual symptoms during the treatment of juxtafoveal CNV associated with candida choroiditis. J Korean Ophthalmol Soc 2014;55(7):1106-1110

Intravitreal Bevacizumab for Nonsubfoveal Choroidal Neovascularization Associated With Angioid Streaks

To evaluate the effects of intravitreal bevacizumab injections in the treatment of nonsubfoveal choroidal neovascularization (CNV) associated with angioid streaks. Nonrandomized, interventional, prospective case series. Fifteen patients (15 eyes) affected by juxtafoveal or extrafoveal CNV secondary to angioid streaks were enrolled in the study. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) measurement on Early Treatment Diabetic Retinopathy Study (ETDRS) chart, optical coherence tomography (OCT), and fluorescein angiography (FA). The protocol treatment included a first injection, followed by repeated injections over a 12-month follow-up period on the basis of the detection of new hemorrhage on biomicroscopic examination, any type of fluid on OCT, or presence of leakage on FA. Mean changes in BCVA and proportion of eyes gaining at least 10 letters (2 ETDRS lines) at the end of the follow-up. Mean changes of central macular thickness (CMT) and extension to the fovea. Mean BCVA did not change throughout the follow-up period, being 0.2 ± 0.2 logMAR at baseline and 0.2 ± 0.3 logMAR at the 12-month examination. A functional improvement of at least 2 ETDRS lines was achieved by 5 eyes (33%), with 3 eyes (20%) gaining 3 lines. Mean CMT at baseline was 215 ± 13 μm and 225 ± 85 μm at the 12-month examination. Two eyes (13.3%) showed CNV extension to the fovea. Intravitreal bevacizumab injection can be a beneficial approach for the management of nonsubfoveal CNV secondary to angioid streaks over a 1-year follow-up.

INTRAVITREAL BEVACIZUMAB FOR JUXTAFOVEAL CHOROIDAL NEOVASCULARIZATION SECONDARY TO MULTIFOCAL CHOROIDITIS

To assess the effects of intravitreal bevacizumab injections in the treatment of juxtafoveal choroidal neovascularization associated with multifocal choroiditis. Prospective interventional case series. Fourteen patients (14 eyes) affected by juxtafoveal choroidal neovascularization secondary to multifocal choroiditis were examined. All patients underwent a complete ophthalmologic examination, including measurement of best-corrected visual acuity using Early Treatment Diabetic Retinopathy Study charts, optical coherence tomography, and fluorescein angiography. The protocol treatment included a first injection, followed by repeated intravitreal bevacizumab injections over a 12-month follow-up period on the basis of optical coherence tomography parameters and angiographic features. Mean best-corrected visual acuity changed from 0.41 logarithm of the minimum angle of resolution (approximately corresponding to 20/51 Snellen equivalent), at baseline, to 0.16 ± 0.13 logarithm of the minimum angle of resolution (approximately corresponding to 20/28 Snellen equivalent), at the 12-month examination (P < 0.002). A functional improvement of at least 3 Early Treatment Diabetic Retinopathy Study lines was achieved by 6 eyes (43%) at the 12-month examination. Mean central macular thickness at baseline was 318 μm, reducing to 239 μm at the 12-month examination (P < 0.001). No eye showed choroidal neovascularization extension to the fovea. Intravitreal bevacizumab is a beneficial treatment for juxtafoveal choroidal neovascularization associated with multifocal choroiditis. Further studies are warranted to confirm these preliminary results.

Ranibizumab versus bevacizumab in choroidal neovascular membrane: Is it worth it?

PurposeThe aim of this study was to compare the short-term outcomes of administration of intravitreal ranibizumab (IVR) and intravitreal bevacizumab (IVB) in the treatment of neovascular age-related macular degeneration (AMD).DesignThis study is a clinical interventional randomized comparative study.Patients and methodsThis randomized clinical trial was performed on 24 eyes of 24 patients with subfoveal and juxtafoveal choroidal neovascularization secondary to AMD. The eyes were randomly assigned to receive 0.5 mg IVR (group 1; 12 eyes) or 1.25 mg IVB (group 2; (12 eyes). Best-corrected visual acuity (BCVA) was assessed, optical coherence tomography was carried out at baseline and repeated at all postoperative follow-up intervals (1 week and 1, 3, and 6 months), and fluorescein angiography was performed at baseline and repeated 1 month after treatment.ResultsIn group 1, the mean age was 62.42 ± 6.75 years (range 51-70 years) and seven of the patients were male (58.33%). In group 2, the mean age was 62.083 ± 7.96 years (range 50-75 years) and four of the patients were male (33.33%). At the sixth month postoperatively, BCVA logMAR significantly improved from 1.01 ± 0.26 (range 1.5-0.7) to 0.82 ± 0.18 (range 1.2-0.5; P = 0.001) in group 1 and from 0.98 ± 0.279 (range 1.4-0.5) to 0.81 ± 0124 (range 1.0-0.7; P = 0.004) in group 2. At 6 months postoperatively, the mean ± SD central macular thickness reduced from 363.33 ± 27.16 μm at baseline (range 319-405 μm) to 291.67 ± 25.79 μm (range 243-335 μm) in group 1 (P = 0.00), whereas in group 2, the mean ± SD central macular thickness moderately reduced from 362.5 ± 20.26 μm at baseline (range 339-400 μm) to 294.17 ± 29.62 μm (range 257-350 μm) at 6 months postoperatively (P = 0.00). There were no significant systemic or ophthalmological adverse effects in either group.ConclusionBoth ranibizumab and bevacizumab are equally safe and effective treatment options as intravitreal injections in the treatment of CNVM due to AMD.