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Intravitreal ranibizumab for myopic choroidal neovascularization – 5-year results and main predictors

Session Details

Session Title: FP-15 Vascular Diseases and Diabetic Retinopathy V

Session Date/Time: Sunday 14/09/2014 | 08:00-10:00

Paper Time: 09:12

Venue: Boulevard D

First Author: : P.Cardoso PORTUGAL

Co Author(s): :    I. Laíns   I. Sobral   C. Farinha   S. Leal   M. Cachulo   R. Silva

Abstract Details

Purpose:

To evaluate the 5-year safety and efficacy of ranibizumab intravitreal injections (IVR) treatment for myopic choroidal neovascularization (CNV) and identify predictors of response.

Setting:

Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Association for Innovation and Biomedical Research on Light (AIBILI), Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

Methods:

Retrospective study. After accessing our database, eyes with diagnosis of high myopia with active CNV confirmed by fluorescein angiography (FA), best-corrected visual acuity (BCVA) ≥ 20/400 and minimum follow-up of 5 years were included. History of previous intraocular treatments, except photodynamic therapy (PDT), and other visual comorbidities were considered exclusion criteria. All subjects had been submitted to complete ophthalmologic examination and optical coherence tomography (OCT) at baseline. During follow-up, patients were examined every 4 to 6 weeks while undergoing treatment and every 2 to 3 months during inactive periods. FA was repeated whenever there was clinical justification. IVR was performed according to pro re nata regime. Retreatment criteria: decrease of BCVA, metamorphopsia, presence of intra or subretinal fluid in OCT, and/or juxtafoveal or subfoveal leakage on FA. For statistical analysis, eyes were divided in 3 groups, according to BCVA results (using ETDRS scale) at 5 years: bad-response (BR) – loss of ≥ 5 letters; stable response (SR) – change of < 5 letters; and good-response (GR) – gain of ≥ 5 letters.

Results:

Thirty-four eyes of 34 patients, mean aged 52.7 ± 17.5 years, were included. At 5 years, mean BCVA remained stable (54.32 ± 16.37 letters baseline and 55.41 ± 20.28 letters 5 years). Gain of vision improved until the second year, despite not reaching statistical significance (+4.32 ± 11.28 versus +6.41 ± 14.95, at 6 and 24 months, respectively). Since then, gain of letters decreased, but remained positive (+4.76 ± 15.58 at 3 years and +0.35 ± 14.52 at 5 years). In the last visit, 38.2% of the eyes were classified as BR and 35.3% as GR. Regarding BR, in all visits there was progressive loss of vision, achieving their worse BCVA at 5 years (p=0.003). Conversely, in GR group there was a progressive gain of vision until the third year (p=0.005) and afterwards it started to decline (+19.33 ± 10.01 versus +16.00 ± 9.07 letters at 3 and 5 years, respectively). Higher baseline BCVA and younger age were significant predictors of BCVA at 5 years (β = 0.75, p=0.003 and β =-0.53, p=0.021, respectively). Number of IVR, history of previous PDT and spherical equivalent presented no significant association. No cases of systemic or ocular side effects were verified

Conclusions:

At 5 years, myopic eyes treated with IVR presented stable BCVA. Younger age and better baseline BCVA predicted better outcomes. Good-responders presented steady increased BCVA in all the performed visits.

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