Three Years Follow-up Results of Ranibizumab Treatment for Choroidal Neovascularization Secondary to Pathologic Myopia

 

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Abstract

Background: Choroidal neovascularization (CNV) secondary to pathological myopia (PM) is one of the main causes of severe visual impairment in patients younger than 50 years. In this analysis we want to demonstrate the long-term results of Ranibizumab treating CNV secondary to PM.

Patients and Methods: We retrospectively analysed 15 treatment naive eyes of 13 patients (10 women, 3 men, mean age: 61.5, SD 11.6, range: 41–80) with visual impairment due to CNV secondary to PM, which were treated with ranibizumab. Criteria for re-treatment were reduction of visual acuity and/or activity in OCT or fluorescence angiography.

Results: We applied a mean of 3 injections (standard deviation [SD] 2.5, range: 1–8) ranibizumab during a mean period of 39.6 months (SD 5.3, range: 31–52). The spherical equivalent was − 12.4 diopters ± 4.1 (range − 7.5 to − 20.5 diopters). Before the first injection mean visual acuity (logMAR) was 0.69 ± 0.26. After one month visual acuity improved to 0.39 ± 0.23 (p = 0.002), after 3 months to 0.30 ± 0.22 (p = 0.002) and after 6 months up to 0.30 ± 0.22 (p = 0.002). After 12 months visual acuity was 0.30 ± 0.22 (p = 0.001) and after 24 months 0.30 ± SD 0.24 (p = 0.001). 11 patients reached a follow-up of at least 36 months and visual acuity was 0.30 ± 0.13 (p = 0,001).

Conclusions: Treating CNV secondary to PM with ranibizumab during a follow-up of 36 months, we found considerable improvement of visual acuity. Compared to treatment of CNV secondary to exudative age-related macular degeneration, CNVs secondary to PM seem to respond faster to ranibizumab treatment and less injections are neccessary to reach stabilization.

Zusammenfassung

Hintergrund: Die choroidale Neovaskularisation (CNV) bei pathologischer Myopie (PM) ist einer der Hauptgründe für eine schwere Beeinträchtigung der Sehschärfe bei Patienten unter 50 Jahren. In dieser Analyse wollen wir Langzeitergebnisse der Therapie von CNVs bei PM mit Ranibizumab darstellen.

Patienten und Methoden: Wir analysierten die Verlaufsentwicklung von 15 bisher unbehandelten Augen von 13 Patienten (10 Frauen, 3 Männer, mittleres Alter 61,5; SD: 11,6; Spanne 41–80 Jahre) mit einer CNV bei PM, die mit Ranibizumab behandelt wurden. Kriterien für die Wiederbehandlung waren eine Sehverschlechterung und/oder Aktivität im OCT oder der Fluoreszenzangiografie.

Ergebnisse: Wir verabreichten im Mittel 3 Injektionen (Standardabweichung [SD] 2,5; Spanne: 1–8) Ranibizumab während einer Nachbeobachtungszeit von durchschnittlich 39,6 Monaten (SD 5,3; Spanne 31–52). Das sphärische Mittel lag bei − 12,4 ± 4,1 dpt (Spanne − 7,5 bis − 20,5 dpt). Vor der 1. Injektion lag die Sehschärfe (logMAR) im Mittel bei 0,69 ± 0,26. Nach einem Monat stieg die Sehschärfe auf 0,39 ± 0,23 (p = 0,002), nach 3 Monaten auf 0,3 ± 0,22 (p = 0,002), nach 6 Monaten auf 0,3 ± 0,22 (p = 0,002) an. Nach 12 Monaten lag die Sehschärfe bei 0,30 ± 0,22 (p = 0,001), nach 24 Monaten bei 0,30 ± 0,24; p = 0,001). 11 Patienten erreichten eine Nachbeobachtungszeit von mindestens 36 Monaten, und die Sehschärfe lag hier bei 0,30 ± 0,13 (p = 0,001).

Schlussfolgerungen: Bei der Behandlung von CNVs bei PM fanden wir während einer Nachbeobachtungszeit von 36 Monaten einen deutlichen Visusanstieg. Im Vergleich zu den Ergebnissen der Therapie von CNVs bei exsudativer altersbedingter Makuladegeneration scheinen CNVs bei PM schneller auf die Ranibizumab-Therapie anzusprechen, und es sind weniger Injektionen nötig, um Stabilität zu erreichen.

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