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HOW VITREOMACULAR INTERFACE MODIFIES THE EFFICACY OF ANTI-VEGF THERAPY FOR MYOPIC CHOROIDAL NEOVASCULARIZATION

Iacono, Pierluigi, MD*; Battaglia Parodi, Maurizio, MD; Iuliano, Lorenzo, MD; Bandello, Francesco, MD

doi: 10.1097/IAE.0000000000001500
Original Study
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Purpose: To evaluate the efficacy of intravitreal ranibizumab in the treatment of myopic choroidal neovascularization (mCNV) complicated by vitreoretinal interface alterations.

Methods: Thirty-two patients affected by mCNV and concurrent vitreoretinal interface disorders, including macular epiretinal membrane (18 patients), lamellar macular hole (4 patients), full-thickness macular hole (1 patient), broad/focal vitreomacular traction (3 patients), broad/focal vitreomacular adhesion (4 patients), and myopic foveoschisis (2 patients), were enrolled in a prospective study. After a comprehensive ophthalmologic examination, including best-corrected visual acuity (BCVA), fluorescein angiography, and spectral-domain optical coherence tomography, each patient received a first intravitreal ranibizumab. Further re-treatments were performed in the presence of choroidal neovascularization activity (new hemorrhages, leakage on fluorescein angiography, intraretinal/subretinal fluid on spectral-domain optical coherence tomography, visual acuity loss of five letters). Main outcome measure was the change in the BCVA and in the central foveal thickness. Data were compared with the historical control group with uncomplicated mCNV.

Results: The median BCVA in the epiretinal membrane–myopic choroidal neovascularization subgroup showed a stabilization from the baseline value of 0.30 logarithm of minimal angle resolution (20/40) to 0.40 (20/50, P: 0.49) at the last visit (30 ± 13 months). Median BCVA significantly improved from 0.30 (20/40) to 0.10 (20/25, P: 0.0005) in the mCNV group and was better than the epiretinal membrane–myopic choroidal neovascularization subgroup (0.008). Central foveal thickness reduced significantly within both groups, with no difference between the groups at the final examination. Considering the vitreoretinal alterations with lower prevalence, BCVA stabilization was registered after a follow-up of 28.9 ± 13 months, with a median BCVA of 0.3 logarithm of minimal angle resolution (20/40) at the baseline and at the final examination. A nonstatistically significant reduction in the median central foveal thickness was registered at the final examination (P: 0.12).

Conclusion: The data show that ranibizumab is effective in controlling mCNV activity when associated with vitreoretinal interface alterations. However, a visual recovery was observed only in patients with uncomplicated mCNV.

The current study examined the effects of intravitreal ranibizumab in the treatment of the myopic choroidal neovascularization complicated by vitreoretinal interface alterations. Although a complete inactivity of the neovascular network was achieved in all the eyes at the final examination, the coexistence of vitreoretinal interface disorders hampered a meaningful visual acuity recovery.

*G.B. Bietti Fondation, IRCCS, Rome, Italy; and

Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milano, Italy.

Reprint requests: Pierluigi Iacono, MD, Fondazione G. B. Bietti per l'Oftalmologia, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Via Livenza 3, 00198m Rome, Italy; e-mail: pierluigi.iacono@libero.it

Supported by Ministry of Health and Fondazione Roma.

F. Bandello is an advisory board member for Allergan, Novartis Pharmaceuticals Corporation, Farmila-Thea, Bayer Schering Pharma, Pfizer, Alcon, Bausch and Lomb, Genentech, Alimera Sciences, Sanofi Aventis, and Thrombogenics. P. Iacono is a consultant for Novartis Pharmaceutical Corporation (Switzerland). The remaining authors have no conflicting interests to disclose.

The study did not receive any additional funding from any of the following organizations: National Institutes of Health; Wellcome Trust; Howard Hughes Medical Institute; and other(s).

© 2018 by Ophthalmic Communications Society, Inc.