Author: Alina Grigoreva (Russian Federation)
Co-authors: Tatiana Iureva, Yulia Kursakova, Elena Ivanova, Dmitry Samsonov
To determine the prognostic criteria for the effectiveness of antiangiogenic therapy in patients with myopic choriodial neovascularization.
Irkutsk Branch of S.Fyodorov "Eye microsurgery" Federal State Institution, Russia
52 patients (52 eyes) active CNV, aged 33,5±5,1, anterior-posterior axis (APA) = 27.8±2.3 mm. Inclusion criteria: female, axial myopia (APA >25.5 mm), chorioretinal neovascularization (CNV) in one or both eyes, active stage, age 25-40 years. For therapeutic purposes, ranibizumab intravitreally at a dose of 0.5 mg in the “pro-re-nata " mode– a mandatory single injection followed by a strategy of repeated administration if necessary. After 12 months from the start of therapy, the number of relapses, injections, and the inclusion of a fellow eye in the pathological process were taken into account. Based on the data obtained, the patients were divided into 2 additional groups. With a favorable clinical course n=31 (31 eyes), age 33.0±5.1, APA 28.5±0.3 mm and an unfavorable clinical course n=21 (21 eyes), age 34.0±4.1, APA 29.01±0.1 mm. In addition to standard ophthalmological methods, highly informative methods were used: spectral optical coherence tomography (SD-OCT), optical coherence tomography in a vascular mode (OCTA) on the Optovue XR Avanti device (USA). Second-level lipidogram with the determination of lipoprotein (a), Apo B/Apo A ratio (Accent 200 Cormay Poland), coagulogram (Helena C-2 UK), indicators of oxidative stress (Form plus Callegari Italy), and the concentration of highly sensitive C - reactive protein.
Patients with a favorable course needed an average of 1.4 ranibizumab injections to suppress the pathological process, in 75% of cases stabilization was after one injection. In the opposition group, complete suppression of CNV activity was in 9.5% of cases. Biometrics (28.7±0.1mm, 29.01±0.1mm, p=0.051), visometry (0.15 to 0.7, p=0.05) showed no significant differences in the two groups. In all patients the mosaic or parquet type of fundus was determined, and "varnish cracks" were visualized. The posterior pole deformation in the form of a shape-domain was revealed. In patients of the first group, CNV was formed by second pattern type (Elsa Bruyère et al. 2017). In the second group, CNV was formed according to the third type. Choroidal thickness varied from 90 to 170 microns, in the opposite group-on average, it did not exceed 50 microns. All patients with myopic CNV had menstrual-ovarian cycle disorders. The levels of cortisol, prolactin and FSH in the second group exceeded the values of the first group by 1.5 times; 1.6 and 1.3 times, respectively (p=0.01), progesterone by 2.2 times (p=0.01), lipoprotein (a) was doubled (p=0.0001). In myopic CNV patients, level of acute phase proteins increased, exceeding the reference values (p=0.001).
A comprehensive assessment of ophthalmic, hormonal and metabolic disorders allowed to develop, justify and implement in clinical practice the technology for determining diagnostic and prognostic criteria for the effectiveness of antiangiogenic therapy in women with myopic CNV. It helps determining the features of the clinical course of the disease at the stage of primary diagnosis, to timely correct the hormonal status and thereby increase the effectiveness of therapeutic measures and prevent the development of CNV in the fellow eye.