J Korean Ophthalmol Soc.  2013 Apr;54(4):610-617. 10.3341/jkos.2013.54.4.610.

Predictive Factors for Visual Outcome after Treatment for Myopic Choroidal Neovascularization

• Oh HN
• Lee JE
• Kim HW
• Yun IH

• KMID: 2216942
• DOI: http://doi.org/10.3341/jkos.2013.54.4.610

Abstract

PURPOSE
To determine predictive factors associated with visual outcome after treatment for myopic choroidal neovascularization (mCNV).
METHODS
Medical records of the patients who underwent photodynamic therapy (PDT), intravitreal anti-vascular endothelial growth factor (Anti-VEGF) injection, or combination therapy of PDT and Anti-VEGF for myopic CNV, and followed up for more than a year, were reviewed retrospectively. Multiple linear regression analyses were performed to evaluate the predictive factors significantly associated with the visual outcome at 1 year after the treatment.
RESULTS
Mean best-corrected visual acuity (BCVA) of 45 eyes of 45 patients showed statistically significant improvement 1 year after the treatment with a mean of 3.5 line improvement (p < 0.01, Wilcoxon signed rank test). Age, 1-month BCVA after treatment and treatment type appeared to be associated with the 1-year visual outcome after treatment for mCNV (p = 0.033, p < 0.001, and p = 0.044, respectively, multivariate linear regression analysis).
CONCLUSIONS
Younger age (less than 40 years), better 1-month BCVA after treatment, intravitreal Anti-VEGF monotherapy were associated with improved visual outcome after treatment for mCNV. In particular, 1-month BCVA after treatment is a useful indicator to predict therapeutic response after treatment for mCNV.

Keyword

Anti-VEGF; Bevacizumab; Myopic CNV; PDT; Ranibizumab

MeSH Terms

Antibodies, Monoclonal, Humanized
Choroid
Choroidal Neovascularization
Endothelial Growth Factors
Eye
Humans
Linear Models
Medical Records
Photochemotherapy
Retrospective Studies
Triazenes
Visual Acuity
Bevacizumab
Ranibizumab
Antibodies, Monoclonal, Humanized
Endothelial Growth Factors
Triazenes

Figure

• 

  Figure 1. Mean best corrected visual acuity (log MAR) changes of all eyes after the first treatment. M ean best-corrected visual acuity (BCVA) of forty five eyes of 45 patients showed statistically significant improvement at each time points after the treatment (p < 0.01, Wilcoxon signed rank test).

• 

  Figure 2. Mean best corrected visual acuity (BCVA, log MAR) changes at 1 year after the first treatment of the groups. M ean BCVA of all groups improved significantly at 1 year after the treatment (p = 0.028, p < 0.01, p = 0.037, respectively, in group A, B and C, W ilcoxon signed rank test).

Reference

References

1. Grossniklaus HE, Green WR. Pathologic findings in pathologic myopia. Retina. 1992; 12:127–33.

2. Hotchkiss ML, Fine SL. Pathologic myopia and choroidal neovascularization. Am J Ophthalmol. 1981; 91:177–83.

3. Ohno-Matsui K, Yoshida T, Futagami S, et al. Patchy atrophy and lacquer cracks predispose to the development of choroidal neovascularisation in pathological myopia. Br J Ophthalmol. 2003; 87:570–3.

4. Bottoni F, Tilanus M. The natural history of juxtafoveal and subfoveal choroidal neovascularization in high myopia. Int Ophthalmol. 2001; 24:249–55.

5. Yoshida T, Ohno-Matsui K, Yasuzumi K, et al. Myopic choroidal neovascularization: a 10-year follow-up. Ophthalmology. 2003; 110:1297–305.

6. Yoshida T, Ohno-Matsui K, Ohtake Y, et al. Long-term visual prognosis of choroidal neovascularization in high myopia: a comparison between age groups. Ophthalmology. 2002; 109:712–9.

7. Blinder KJ, Blumenkranz MS, Bressler NM, et al. Verteporfin therapy of subfoveal choroidal neovascularization in pathologic myopia: 2-year results of a randomized clinical trial - VIP report no. 3. Ophthalmology. 2003; 110:667–73.

8. Lam DS, Chan WM, Liu DT, et al. Photodynamic therapy with verteporfin for subfoveal choroidal neovascularisation of pathologic myopia in Chinese eyes: a prospective series of 1 and 2 year follow up. Br J Ophthalmol. 2004; 88:1315–9.

9. Schnurrbusch UE, Jochmann C, Wiedemann P, Wolf S. Quantitative assessment of the long-term effect of photodynamic therapy in patients with pathologic myopia. Graefes Arch Clin Exp Ophthalmol. 2005; 243:829–33.

10. Pece A, Isola V, Vadalà M, Matranga D. Photodynamic therapy with verteporfin for subfoveal choroidal neovascularization secondary to pathologic myopia: long-term study. Retina. 2006; 26:746–51.

11. Chen YS, Lin JY, Tseng SY, et al. Photodynamic therapy for Taiwanese patients with pathologic myopia: a 2-year follow-up. Retina. 2007; 27:839–45.

12. Cohen SY. Anti-VEGF drugs as the 2009 first-line therapy for choroidal neovascularization in pathologic myopia. Retina. 2009; 29:1062–6.

13. Byeon SH, Kwon OW, Lee SC, et al. Indocyanine green angio-graphic features of myopic subfoveal choroidal neovascularization as a prognostic factor after photodynamic therapy. Korean J Ophthalmol. 2006; 20:18–25.

14. Kuo JZ, Ong FS, Yeung L, et al. Predictive factors for visual outcome to intravitreal bevacizumab in young Chinese patients with myopic choroidal neovascularization. Retina. 2011; 31:1835–40.

15. Yoon JU, Kim YM, Lee SJ, et al. Prognostic factors for visual outcome after intravitreal anti-vegf injection for naive myopic choroidal neovascularization. Retina. 2012; [Epub ahead of print].

16. Axer-Siegel R, Ehrlich R, Yassur Y, et al. Photodynamic therapy for age-related macular degeneration in a clinical setting: visual results and angiographic patterns. Am J Ophthalmol. 2004; 137:258–64.

17. Hampton GR, Kohen D, Bird AC. Visual prognosis of disciform degeneration in myopia. Ophthalmology. 1983; 90:923–6.

18. Secrétan M, Kuhn D, Soubrane G, Coscas G. Long-term visual outcome of choroidal neovascularization in pathologic myopia: natural history and laser treatment. Eur J Ophthalmol. 1997; 7:307–16.

19. Brancato R, Pece A, Avanza P, Radrizzani E. Photocoagulation scar expansion after laser therapy for choroidal neovascularization in degenerative myopia. Retina. 1990; 10:239–43.

20. Pece A, Brancato R, Avanza P, et al. Laser photocoagulation of choroidal neovascularization in pathologic myopia: long-term results. Int Ophthalmol. 1994-1995; 18:339–44.

21. Ruiz-Moreno JM, Montero JA. Long-term visual acuity after argon green laser photocoagulation of juxtafoveal choroidal neovascularization in highly myopic eyes. Eur J Ophthalmol. 2002; 12:117–22.

22. Virgili G, Varano M, Giacomelli G, et al. Photodynamic therapy for nonsubfoveal choroidal neovascularization in 100 eyes with pathologic myopia. Am J Ophthalmol. 2007; 143:77–82.

23. Pece A, Vadalà M, Isola V, Matranga D. Photodynamic therapy with verteporfin for juxtafoveal choroidal neovascularization in pathologic myopia: a long-term follow-up study. Am J Ophthalmol. 2007; 143:449–54.

24. Gibson J. Photodynamic therapy with verteporfin for juxtafoveal choroidal neovascularisation secondary to pathological myopia. Eye (Lond). 2005; 19:829–30.

25. Lam DS, Liu DT, Fan DS, et al. Photodynamic therapy with verteporfin for juxtafoveal choroidal neovascularization secondary to pathologic myopia-1-year results of a prospective series. Eye (Lond). 2005; 19:834–40.

26. Gelisken F, Inhoffen W, Hermann A, et al. Verteporfin photodynamic therapy for extrafoveal choroidal neovascularisation in pathologic myopia. Graefes Arch Clin Exp Ophthalmol. 2004; 242:926–30.

27. Chan WM, Lai TY, Wong AL, et al. Combined photodynamic therapy and intravitreal triamcinolone injection for the treatment of choroidal neovascularisation secondary to pathological myopia: a pilot study. Br J Ophthalmol. 2007; 91:174–9.

28. Marticorena J, Gomez-Ulla F, Fernandez M, et al. Combined photodynamic therapy and intravitreal triamcinolone acetonide for the treatment of myopic subfoveal choroidal neovascularization. Am J Ophthalmol. 2006; 142:335–7.

29. Rishi P, Rishi E, Venkataraman A, et al. Photodynamic mono-therapy or combination treatment with intravitreal triamcinolone acetonide, bevacizumab or ranibizumab for choroidal neovascularization associated with pathological myopia. Indian J Ophthalmol. 2011; 59:242–6.

30. Manzano RP, Peyman GA, Khan P, Kivilcim M. Testing intravitreal toxicity of bevacizumab (Avastin). Retina. 2006; 26:257–61.

31. Gharbiya M, Giustolisi R, Allievi F, et al. Choroidal neovascularization in pathologic myopia: intravitreal ranibizumab versus bevacizumab-a randomized controlled trial. Am J Ophthalmol. 2010; 149:458–64.

32. Matsuo M, Honda S, Matsumiya W, et al. Comparison between anti-vascular endothelial growth factor therapy and photodynamic therapy for myopic choroidal neovascularization. Eur J Ophthalmol. 2012; 22:210–5.

33. Ikuno Y, Nagai Y, Matsuda S, et al. Two-year visual results for older Asian women treated with photodynamic therapy or bevacizumab for myopic choroidal neovascularization. Am J Ophthalmol. 2010; 149:140–6.

34. Peiretti E, Vinci M, Fossarello M. Intravitreal bevacizumab as a treatment for choroidal neovascularisation secondary to myopia: 4-year study results. Can J Ophthalmol. 2012; 47:28–33.

35. Axer-Siegel R, Ehrlich R, Weinberger D, et al. Photodynamic therapy of subfoveal choroidal neovascularization in high myopia in a clinical setting: visual outcome in relation to age at treatment. Am J Ophthalmol. 2004; 138:602–7.

36. Ikuno Y, Sayanagi K, Soga K, et al. Intravitreal Bevacizumab for choroidal neovascularization attributable to pathological myopia: one-year results. Am J Ophthalmol. 2009; 147:94–100.

37. Gharbiya M, Allievi F, Mazzeo L, Gabrieli CB. Intravitreal bevacizumab treatment for choroidal neovascularization in pathologic myopia: 12-month results. Am J Ophthalmol. 2009; 147:84–93.

38. Nakanishi H, Tsujikawa A, Yodoi Y, et al. Prognostic factors for visual outcomes 2-years after intravitreal bevacizumab for myopic choroidal neovascularization. Eye (Lond). 2011; 25:375–81.