Vascular remodeling of choroidal neovascularization in older myopic patients treated with ranibizumab

Graefes Arch Clin Exp Ophthalmol. 2019 Mar;257(3):485-493. doi: 10.1007/s00417-018-04205-x. Epub 2018 Dec 7.

Abstract

Purpose: To investigate morphological changes in myopic choroidal neovascularization (mCNV) using optical coherence tomography-angiography (OCT-A) after treatment with ranibizumab.

Methods: Retrospective analysis of consecutive patients over a 24-month period. All treatment-naïve mCNV were imaged at baseline with color pictures, spectral-domain OCT and OCT-A, and fluorescein angiography in selected cases. CNV morphology was classified at baseline and at 6 months. The CNV lesion surface was also compared.

Results: Twenty-nine patients with a mean age of 70.3 ± 10.1 years were included. They received a mean number of 2.65 injections over 6 months. Best-corrected visual acuity improved from 62.2 to 68.5 letters (p = 0.004), with regression of exudation in 24 eyes (82.7%). Baseline CNV was classified into tree-in-bud (16 eyes), medusa (9 eyes), or sea-fan (4 eyes) pattern. At 6 months, no abnormal blood flow was observed in CNV in 13 eyes. Eyes with complete regression or evolution towards an indistinct pattern showed more often a complete regression of exudation than eyes with unchanged pattern (p = 0.007). The mean CNV surface significantly decreased from 0.19 to 0.08 mm2 (p < 0.0001).

Conclusion: An unchanged pattern was more often associated with exudation persistence, while a complete regression or evolution towards indistinct pattern was always associated with vascular inactivity. However, variable changes in mCNV were observed after anti-VEGF. Thus, OCT-A could be more useful in the diagnosis than in the follow-up of mCNV.

Keywords: Anti-VEGF; Choroidal neovascularization; Myopia; OCT-angiography; Ranibizumab.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Angiogenesis Inhibitors
  • Choroid / blood supply
  • Choroidal Neovascularization / diagnosis
  • Choroidal Neovascularization / drug therapy*
  • Choroidal Neovascularization / etiology
  • Disease Progression
  • Dose-Response Relationship, Drug
  • Female
  • Fluorescein Angiography / methods
  • Follow-Up Studies
  • Fundus Oculi
  • Humans
  • Intravitreal Injections
  • Male
  • Myopia / complications*
  • Myopia / physiopathology
  • Ranibizumab / administration & dosage*
  • Refraction, Ocular
  • Regional Blood Flow / drug effects
  • Regional Blood Flow / physiology*
  • Retinal Vessels / diagnostic imaging
  • Retinal Vessels / physiopathology*
  • Retrospective Studies
  • Tomography, Optical Coherence / methods
  • Treatment Outcome
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors
  • Vascular Remodeling / physiology*

Substances

  • Angiogenesis Inhibitors
  • Vascular Endothelial Growth Factor A
  • Ranibizumab