First Author: Y.Yang UK
Co Author(s): Y. Khan R. Hamilton
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Choroidal neovascularisation is a serious complication of pathological myopia that can affect particularly those of a working age. Treatment in the form of intravitreal ranibizimab has been approved by the National Institute of Clinical Excellence (NICE) since November 2013. The aim of the audit was to analyse the outcome of such treated patients over a 24 month period.
Moorfields Eye Hospital, London
Retrospective case note review was conducted for all patients diagnosed with treatment-naïve juxtafoveal or subfoveal myopic CNVM between March and November 2014 who underwent 0.5mg of intravitreal ranibizumab injection(s) on a pro re nata basis. Data collection included: Best corrected visual acuity (BCVA), improvement in BCVA from baseline to 24 months, refractive error, number of injections, retinal thickness parameters from Optical Coherence Tomography (OCT) imaging of lesions, fundus fluorescein angiography (FFA) findings, features of myopic retinopathy present, duration of symptoms prior to diagnosis, and safety profile for each course of treatment.
35 eyes from 35 patients (18 Male, 17 Female) were analysed, with a mean age of 52 and mean central retinal thickness of 369 microns on baseline OCT. Out of 35 patients, 26 completed 24 months of follow up while 7 patients were deemed stable and following a minimum of 12 months follow up were discharged with no subsequent re-referral. One patient was lost to follow-up 6 months post treatment initiation. Mean number of intravitreal injections during follow-up was 4.27 injections (range 1 to 21). There was a statistically significant improvement in mean BCVA from baseline logMAR 0.67 to final recorded BCVA of logMAR 0.45 (p=0.004 paired t-test). OCT demonstrated alteration or loss of the inner/outer-segment junction with hyper-reflective haze at the interface of myopic CNVM. Treatment resulted in morphological improvement of the lesion; however ellipsoid layer changes persisted in most patients. FFA typically revealed early hyperfluorescence in sub/juxta-foveal zones. No active leakage from the CNVM lesion was detected in 8 of 35 eyes (23%). One case of full thickness macular hole was evident following initial intravitreal injection. This was associated with BCVA of logMAR 0.3 and managed conservatively by the vitreoretinal team. There were no other adverse events.
The treatment of choroidal neovascularisation secondary to pathological myopia was treated effectively with intravitreal ranibizumab in patient population. There was disease control with a relatively low number of injections over a significant follow up period. More than half of patients (55%) who presented with BCVA below the legal driving standard of logMAR 0.3 were able to achieve driving level standard vision or above in the affected eye following treatment.