J Korean Ophthalmol Soc.  2019 Jun;60(6):547-554. 10.3341/jkos.2019.60.6.547.

Long-term Treatment Outcomes of Intravitreal Bevacizumab Treatment for Myopic Choroidal Neovascularization

• Lee JM
• Kim JW
• Lee DW
• Kim JH

• KMID: 2449708
• DOI: http://doi.org/10.3341/jkos.2019.60.6.547

Abstract

PURPOSE
To evaluate the long-term treatment outcomes of bevacizumab therapy in patients with myopic choroidal neovascularization (CNV).
METHODS
A retrospective review was performed of medical records regarding 43 eyes with myopic CNV that were treated with intravitreal bevacizumab injection. Visual acuity at diagnosis was compared with that measured at the final follow-up; the incidence and timing of re-activation were evaluated. In addition, factors associated with final follow-up were analyzed.
RESULTS
Mean patient age was 39.3 ± 12.9 years and mean spherical equivalent (SE) was −11.9 ± 4.4 diopters. Patients were followed-up at a mean of 42.1 ± 17.0 months. Re-activation of the lesion was noted in 17 eyes (39.5%). The mean time to first re-activation was 19.5 ± 15.4 months from the time that resolution of subretinal fluid/retinal fluid was confirmed after initial treatment. The mean visual acuity (the logarithm of the minimal angle of resolution) was 0.40 ± 0.25 at diagnosis and 0.26 ± 0.31 at the final follow-up. Visual acuity at the final follow-up was significantly improved when compared with the baseline value (p = 0.005). Patient age (p < 0.001), SE (p = 0.003), and visual acuity at diagnosis (p < 0.001) were significantly associated with visual acuity at the final follow-up.
CONCLUSIONS
Bevacizumab therapy was a useful method for long-term treatment of myopic CNV. The observation of relatively late re-activation after the initial treatment suggests a need for continuous long-term follow-up.

Keyword

Bevacizumab; Choroidal neovascularization; Myopia

MeSH Terms

Bevacizumab*
Choroid*
Choroidal Neovascularization*
Diagnosis
Follow-Up Studies
Humans
Incidence
Medical Records
Methods
Myopia
Retrospective Studies
Visual Acuity
Bevacizumab

Figure

• 

  Figure 1. Clinical course of a 52 year-old patient who was diagnosed with myopic choroidal neovascularization (CNV) in the left eye. At diagnosis, myopic fundus (A) and active leakage from CNV was noted on fluorescein angiography (B), and subretinal fluid with hyper-reflective material was noted on optical coherence tomography (C). The patient was treated with 3 monthly intravitreal bevacizumab injections. One month after the third injection (D), the fluid had completely resolved. At 48 months after the confirmation of the fluid resolution, first re-activation of the lesion was noted accompanied with the development of retinal hemorrhage (E, F). The patient received additional bevacizumab injection and the fluid and hemorrhage had completely resolved one month after the treatment (G).

• 

  Figure 2. A Kaplan-Meier curve showing the cumulative re-activation of the myopic choroidal neovascularization after identification of complete resolution of fluid following the initial treatment. Among the 43 eyes, 17 eyes (39.5%) showed re-activation of the lesion during the follow-up period.

• 

  Figure 3. Changes in BCVA in patients with myopic choroidal neovascularization who were treated with intravitreal bevacizumab. Statistical analysis was performed using repeated measures analysis of variances with a Bonferroni's correction. ‘Final visit’ showed mean 42.1 ± 17.0 months. BCVA = best-corrected visual acuity; logMAR = the logarithm of minimal angle of resolution.

Reference

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