First Author: J.Coelho PORTUGAL
Co Author(s): L. Malheiro M. Gomes M. Macedo M. Furtado A. Meireles M. Lume
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To evaluate the frequency and impact on visual acuity of macular Bruch membrane (BM) defects in patients treated with anti-vascular endothelial growth factors (VEGF) for choroidal neovascularization (CNV) secondary to pathological myopia.
Department of Ophthalmology of a tertiary referral centre in Oporto, Portugal - Centro Hospitalar Universitário do Porto
Single centre retrospective observational case series of patients with CNV secondary to pathologic myopia treated with one anti-VEGF injection followed by a pro re nata (1 + PRN) regimen. Patients' demographic data, best-corrected visual acuity (BCVA) measured with an ETDRS chart and number of intravitreal injections were recorded. Spectral Domain optical coherence tomography (SD-OCT) was done at each visit. Fluorescein angiography was done at baseline and whenever necessary. Retreatment criteria included reduction in BCVA of 5 or more letters, recurrent or increasing of metamorphopsia, new CNV or haemorrhage at fundus examination, any fluid on OCT or leakage on fluorescein angiography. Chorioretinal atrophy was assessed by fundus examination, fluorescein angiography and SD-OCT. Macular BM defects were characterized by lack of BM, retinal pigment epithelium, photoreceptors and choriocapillaris. Main outcome measures were the presence of macular BM defects and its effect on visual outcomes and anti-VEGF treatment efficacy.
62 eyes from 56 patients, mean age of 56,7±14,7 years, most female (78,6%) were included. Mean follow-up was 29,7±20,5 months and mean number of anti-VEGF injections was 6,5±5,3 (1-30). At baseline 30,6% of eyes showed macular BM defects increasing to 40,3% at the final visit (p<0,001). There were no differences in age, time of follow-up, baseline BCVA and number of anti-VEGF injections between eyes with and without macular BM defects seen at baseline or at last visit (p>0,05). At last visit, mean BCVA had decreased by -4,53±22,82 ETDRS letters in eyes with BM defects at baseline and had increased by + 9,26±18,38 ETDRS letters in eyes without BM defects (p=0,004). Eyes with BM defects at last visit had a mean BCVA of 40,4±24,5 vs 63,5±16,7 ETDRS letters seen in eyes without defects (p<0,001). Only 5 out of 19 eyes (26,3%) with baseline BM defects had increased BCVA during follow-up (p=0,005). At last observation myopic CNV-related macular atrophy was present in 48,4% (n=30) and in these eyes macular BM defects were seen in 83,3%, 25 out of 30 (p<0,001). After anti-VEGF therapy increase in BCVA was more frequent and significant in eyes with myopic CNV-related macular atrophy without BM defects (p<0,05).
Macular Bruch membrane defects are characterized by a lack of retinal pigment epithelium and photoreceptors are often seen in myopic CNV and have a profound impact in visual acuity and prognosis. Eyes with macular Bruch membrane defects have a poorer response to anti-VEGF therapy and worse visual outcomes when compared to eyes without disruption of Bruch membrane.