Author: Evgenii Bobykin (Russian Federation)
Co-authors: Irina Kulakova, Vadim Krokhalev
Purpose
Purpose: to evaluate the effectiveness of anti-VEGF therapy for myopic choroidal neovascularization (mCNV) in 12 to 60 months follow-up or longer in real clinical practice.
Setting/Venue
Setting: Ural State Medical University (Yekaterinburg, Russian Federation).
Methods
Methods. A retrospective single-center study was carried out. It included an analysis of the medical data of patients with mCNV treated with intravitreal injections of ranibizumab (0.5 mg) and / or aflibercept (2.0 mg) in 1+ PRN regimen. Inclusion criteria: mCNV with signs of exudative activity confirmed by optical coherence tomography (OCT) and / or fundus fluorescence angiography; the length of the axis of the eyeball is more than 25mm. Exclusion criteria: follow-up less than 12 months; gross violations by the patient of the treatment regimen (low level of compliance, expressed in the refusal to continue monitoring or therapy) during the first year of the study. The study group consisted of 45 patients (49 eyes), incl. 8 (17.8%) men and 37 (82.2%) women aged 25 to 79 years (median (Me) - 53; 25% and 75% quartile (Q25; Q75) [44; 62] years). The duration of follow-up ranged from 12 to 107 months (median - 56 [26; 75]). Statistical processing was carried out using the statistical software package Statistica 13.5.0. To assess the significance of differences in the studied samples, a simple nonparametric Wilcoxon test for dependent samples was used. Statistical hypotheses were considered confirmed at a significance level of p <0.05.
Results
Results. To analyze the results of treatment, subgroups of patients were identified who were under observation for at least 12 (n = 49), 24 (n = 40) and 36 (n = 30) months, as well as more than 5 years (n = 16). In all studied subgroups, there was a statistically significant (p <0.05) improvement in the functional (increase in BCVA) and anatomical (decrease in CRT) parameters in the first year of treatment, which remained throughout the observation period. The average BCVA value in the study group increased during the observation period by 0.23 (from the initial 0.27 to the final 0.5). In the course of observation, the parameters of CRT decreased by an average of 88.1 microns (from the initial 333.7 to the final 245.6). Relapses of mCNV activity occurred in 30 (61.2%) cases. The resumption of anti-VEGF therapy in the second year of follow-up was required in 32.5% of cases (13 out of 40 patients), in the third - in 36.7% (11/30), in the fourth - in 24.0% (6/25), in the fifth - in 33.3% (7/21), in the sixth - in 37.5% (6/16), in the seventh - in 28.6% (2/7).
Conlusions
Conclusion. A retrospective assessment of the initial status of the eyes included in the study was carried out, taking into account the presence of atrophic, traction and neovascular components and their severity according to ophthalmoscopy and OCT diagnostics in accordance with the modern ATN classification (Ruiz-Medrano J. et al., 2019). The atrophic component (A) was most often represented by diffuse chorioretinal atrophy (A2) - 34 cases (69.4%). The most common variant of the traction component (T) was the absence of macular schisis (T0), detected in 39 eyes (79.6%). The neovascular component (N), along with active mCNV (N2), which was the criterion for inclusion in the study, was represented by lacquer cracks (N1), identified in 4 cases (8.2%). The high efficacy of anti-VEGF therapy of mCNV with ranibizumab and aflibercept was confirmed in real clinical practice, which was expressed in a statistically significant (p <0.05) increase in BCVA and a decrease in СRT during treatment. The dynamics of parameters, achieved in the first year of treatment, persisted within 36 months (n = 30) and more than 5 years (61-107 months, n = 16). In several cases, unrelated progression of concomitant mCNV traction and atrophic conditions, as well as cataracts, was recorded.
Financial Disclosure
I am a consultant for Bayer and Novartis
Comments
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