Long-Term Follow-Up of Choroidal Neovascularization in Pathological Myopia Treated with Intravitreal Ranibizumab

 

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Abstract

Background: The purpose of this contribution is to report our functional results on the efficacy of intravitreal ranibizumab for submacular choroidal neovessels (CNV) in high myopia, and to compare the roles of optical coherence tomography (OCT), fluorescein angiography and visual acuity changes in the treatment decision prior to each injection. Patients and Methods: This is a retrospective study performed in Jules Gonin Eye Hospital. It included all patients with myopic CNV treated with intravitreal ranibizumab injections with a minimum follow-up of 24 months. After an induction dosing from 1 to 3 injections, the follow-up was based on a pro re nata regimen. Ophthalmic evaluation, best corrected visual acuity, and OCT were done at each visit, and fluorescein angiography at baseline and if neovascular activity was suspected. Retreatment criteria included metamorphopsia, visual loss of ≥ 5 ETDRS letters, any fluid on OCT and/or leakage on fluorescein angiography. Results: 24 eyes were included in the study. Mean follow-up was 49 months. Mean visual acuity improved significantly from 62.8 ± 13.8 letters at baseline to 72.8 ± 12.9 letters at last follow-up visit (p = 0.001). The mean number of injections was 2.2 in the first year and below 1 for the following years. The sensitivities of fluorescein angiography, SD OCT, and visual acuity loss ≥ 5 letters were 62.6 %, 51.4 %, and 40 %, respectively. The fluorescein angiography showed a significantly higher sensitivity in treatment decision than OCT (p = 0.007). Conclusion: Our study has shown that ranibizumab injections provide a significant long-term visual benefit in myopic CNV with a small number of injections. Fluorescein angiography has a preponderant role in the treatment decision of active myopic CNV.

Zusammenfassung

Hintergrund: Ziel der Studie war es, die funktionellen Resultate von intravitrealem Ranibizumab für submakuläre choroidale Neovaskularisationen (CNV) bei hoher Myopie zu beschreiben, und dabei die Rolle der optischen Kohärenztomografie (OCT), der Fluoreszein-Angiografie und von Visusveränderungen in Bezug auf die Behandlungsentscheidung zu untersuchen. Patienten und Methoden: Diese retrospektive Studie schloss Patienten ein, die im Universitätsspital Jules Gonin wegen myoper CNV mit intravitrealem Ranibizumab behandelt wurden und mindestens 24 Monate kontrolliert respektive behandelt wurden. Nach initialen 1–3-monatlichen intravitrealem Ranibizumabdosen wurden die Patienten gemäß einem Pro-re-nata-Schema weiterbehandelt. Bei jeder Untersuchung wurde ein kompletter ophthalmologischer Status erhoben, die best korrigierte Sehschärfe gemessen, und ein OCT gemacht. Eine Fluoreszein-Angiografie wurde zu Beginn und bei Verdacht auf neovaskuläre Aktivität durchgeführt. Wiederbehandlungskriterien beinhalteten Metamorphopsien, einen Visusverlust von 5 oder mehr ETDRS-Buchstaben und/oder im OCT nachgewiesene Flüssigkeit, respektive exudative Aktivität in der Fluoreszein-Angiografie. Resultate: 24 Augen mit mittlerer Nachbeobachtungszeit von 49 Monaten wurden in die Studie eingeschlossen. Die Sehschärfe verbesserte sich im Mittel signifikant von initial 62,8 ± 13,8 Buchstaben auf 72,8 ± 12,9 Buchstaben bei der letzten Untersuchung (p = 0,001). Die mittlere Anzahl Injektion lag bei 2,2 im 1. Jahr und unter 1 in den Folgejahren. Die Sensitivität der Fluoreszein-Angiografie, des OCT und des Sehschärfeverlustes von 5 oder mehr Buchstaben lag bei 62,6 %, 51,4 %, respektive 40 %. Die Fluoreszein-Angiografie zeigte signifikant höhere Sensitivität bei der Wiederbehandlungsentscheidung als das OCT (p = 0,007). Schlussfolgerung: Diese Studie zeigte langfristige und signifikante Visuserfolge der Ranibizumab-Behandlung für myope CNV mit sehr geringer Anzahl von Injektionen. Die Fluoreszein-Angiografie hat eine zentrale Rolle in der Wiederbehandlungsentscheidung bei aktiven myopen Membranen.

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