Author: Alicia Canalejo Oliva (Spain)
Co-authors: Maria Isabel López Gálvez
Purpose
To analyze the frequency and characteristics of choroidal neovascularization (CNV) in old patients with high myopia, as well as its response to treatment compared to published data. The aim of this study is also to determine whether the treatment with one single injection of Anti-VEGF on a Pro Re Nata (PRN) basis is effective in this subgroup of patients.
Setting/Venue
This retrospective study has been conducted at the retina unit of the Hospital Clinico Universitario de Valladolid (HCUV), Spain. Data collection from medical records for the period between 2014 and 2020 started after the approval of the Clinical Research Ethics Committee for the area of eastern Valladolid. Only patients previously diagnosed of high myopia were included.
Methods
A retrospective observational study in 91 patients with high myopia and choroidal neovascularization. Inclusion criteria were patients over 18 years who suffered from pathologic myopia and have been diagnosed of choroidal neovascularization. All patients underwent treatment with intravitreal Anti-Vascular Endothelial Growth Factor (Anti-VEGF) and were followed for a minimum period of 1 year and a maximum of 6 years. Best Corrected Visual Acuity (BCVA) and Central Retinal Thickness (CRT) progression was studied before and after treatment for patients exhibiting a CNV type 1 in Optical Coherence Tomography (OCT), as well as for patients with a type 2 CNV. Additionally, CNV phenotype and response to treatment in patients under 60 years was analyzed separately from older patients. The Anti-VEGF agent, as well as the number of injections administered in the first year and during the complete follow up period were recorded.
Results
CNV type 1 is higher than expected (n=40, 44%) in patients with high myopia. BCVA improved significantly one month after the first injection in both samples, although type 2 CNV demonstrated a better response to treatment (from 0,71 to 0,56) than type 1 CNV (from 0,75 to 0,62), p< 0.05. Mean (SD) age at onset is 67,9 years (14,4 years). Patients under 60 years (n=25, 27´47%) demonstrated a gain of 15 ETDRS letters after three months, while older patients showed a 5 ETDRS letters gain. (p=0,115). The first group received 2,59 injections in the first year and 2,96 during the whole period. On the other hand, 3,25 injections in the first year and 3,94 in total were administrated for the older group.
Conlusions
Patients with high myopia over 60 years are more likely to exhibit a CNV type 1, therefore altering the course and prognosis of a typical myopic CNV. It may be hypothesized that older people with morphological features of CNV due to ageing changes could benefit from a proactive therapy, with three initial injections followed by a PRN regimen.
Financial Disclosure
No financial relations
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