Comparison of photodynamic therapy, ranibizumab/bevacizumab or combination in the treatment of myopic choroidal neovascularisation: a 9-year-study from a single centre. Issue 10 (20th January 2016)

• Record Type: Journal Article
• Authors: Rishi, Pukhraj; Rishi, Ekta; Bhende, Muna; Agarwal, Vishvesh; Vyas, Chinmayi H; Valiveti, Meenakshi; Bhende, Pramod; Rao, Chetan; Susvar, Pradeep; Sen, Parveen; Raman, Rajiv; Khetan, Vikas; Murali, Vinata; Ratra, Dhanashree; Sharma, Tarun
• Is Part Of: British journal of ophthalmology. Volume 100:Issue 10(2016)
• Page Start: 1337
• Page End: 1340
• Publication Date: 2016-01-20
• Subjects: Macula -- Neovascularisation -- Treatment Medical -- Retina -- Treatment Lasers; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2015-307802
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Aim: To compare treatment outcomes for myopic choroidal neovascularisation (CNV) managed with verteporfin photodynamic therapy (vPDT), intravitreal antivascular endothelial growth factor (anti-VEGF, bevacizumab/ranibizumab) agents or combination thereof. Methods: Clinical data of 79 eyes with myopic CNV examined from March 2004 to July 2013 was retrospectively reviewed. Patients were managed with vPDT, intravitreal bevacizumab (1.25 mg/0.05 mL)/ranibizumab (0.5 mg/0.05 mL) or a combination of vPDT and anti-VEGF. Outcome measures included complete regression (scarring) of CNV and best-corrected visual acuity (BCVA). Results: Treatments provided were vPDT (n=23), anti-VEGF (n=25) (ranibizumab, n=12; bevacizumab, n=13), vPDT+anti-VEGF (n=31). Mean logMAR BCVA changed from 0.59±0.44 to 0.49±0.40 at mean follow-up of 54.63±39.46 months. Mean logMAR vision changed from 0.68±0.57, 0.54±0.48 and 0.59±0.39 at presentation to 0.59±0.53, 0.38±0.44 and 0.37±0.37 at last follow-up in PDT (p=0.4), anti-VEGF (p=0.1) and vPDT+anti-VEGF groups (p=0.0002), respectively. CNV was scarred in 64 eyes (81%) at mean 11.03±13.56 months. Most common complication was macular scar (n=64), associated with reduced (n=17) or preserved (n=47) vision. Chorioretinal atrophy attributable to vPDT was seen in five eyes (vPDT, n=3; vPDT+anti-VEGF, n=2). Conclusion: Combination of vPDT and intravitreal anti-VEGF (ranibizumab/bevacizumab) was associated with better visual outcomes and higher rates of regression in eyes with myopic CNV as compared with monotherapy with PDT or anti-VEGF. Larger size of CNV, and high refractive error were independent risk factors for poor visual outcomes.