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Visual acuity outcomes of ranibizumab vs verteporfirin photodynamic therapy (vPDT) treatment response in highly myopic eyes with dome shaped macular feature and choroidal neovascularisation

Session Details

Session Title: New Drug Treatment

Session Date/Time: Saturday 13/09/2014 | 14:30-16:30

Paper Time: 14:38

Venue: Boulevard F

First Author: : L.Ceklic SWITZERLAND

Co Author(s): :    U. Wolf-Schnurrbusch   S. Wolf           

Abstract Details

Purpose:

to investigate the frequency of the dome shaped macular feature (DSM) feature in eyes with myopic choroidal neovascularisation (mCNV) and the influence of dome shaped macular feature on treatment with ranibizumab for mCNV.

Setting:

DSM has been described in patients with pathologic myopia as inward bulge inside the chorioretinal posterior concavity of the eye in macular area. The pathophysiology of DSM include localized choroidal thickening, sclera infolding and vitreomacular traction. DSM may be associated with RPE atrophy, subfoveal fluid and visual loss.

Methods:

This analysis included 276 patients with pathological myopia from the RADIANCE study. We performed post-hoc analyses for the retrospectively defined subgroup of patients with the DSM feature present in the study eye baseline. The OCT volume scans as well as the cross hair scans were analyzed for the presence of the DSM feature. Outcomes of this subanalysis were changes in best corrected visual acuity (BCVA) at month 3 and month 12 as compared with baseline. Outcomes were evaluated in all patients who completed the RADIANCE study treated solely with ranibizumab or vPDT from baseline to month 12 using the last observation carried forward method.

Results:

A total of 50 (18%) were identified with the DSM feature. Out of the 50 patients with DSM, 38 patients were treated with ranibizumab and 12 with vPDT. Baseline BCVA was significantly lower in patients with DSM as compared with patients without DSM (50±11.5 letters vs 56.5±13.2 letters, p<0.01). Among the ranibizumab treated patients follow up at month 3 (with DSM (n=38); 11.1±9.14 vs no DSM (n=183); 10.5±10.7 letters, p=0.08) and at month 12 ( with DSM (n=38); 12.1±10.9 vs no DSM (n=183); 14±10.68 letters, p=0.09) registered no significant differences in visual gain between the DSM and non DSM groups. The number of ranibizumab injections were similar in both groups (3.9±2.85). For vPDT treated patients, those with DSM had better visual acuity outcome after month 3 compared to those without DSM (with DSM (n=12); 7.3±12.2 letters vs no DSM (n=43); 1.2±12.9 letters, p<0.05).

Conclusions:

Our study suggests that intravitreal injections of ranibizumab for the treatment of mCNV are equally beneficial in eyes with or without the DSM feature. For patients with vPDT those with DSM feature appear to have a better visual response compared to patients without DSM feature but this could be taken carefully because of relatively small number of patients treated with vPDT in the RADIANCE study.

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