Choroidal neovascularization in pathological myopia

Intravitreal bevacizumab for choroidal neovascularization attributable to pathological myopia: one-year results.

Choroidal neovascularisation (CNV) is a common vision-threatening complication of myopia and pathological myopia. Despite significant advances in understanding the epidemiology, pathogenesis and natural history of myopic CNV, there is no standard definition of myopic CNV and its relationship to axial length and other myopic degenerative changes. Several treatments are available to ophthalmologists, but with the advent of new therapies there is a need for further consensus and clinical management recommendations. Verteporfin photodynamic therapy has been an established treatment for subfoveal myopic CNV for many years, but this treatment does not restore visual acuity and is associated with long-term chorioretinal atrophy. More recently, clinical trials investigating the efficacy and safety of anti-vascular endothelial growth factor agents in patients with myopic CNV have demonstrated substantial visual acuity gains and quality of life increases compared with photodynamic therapy. These enhanced outcomes provide updated evidence-based clinical management guidelines of myopic CNV, and increase the need for a generally accepted definition for myopic CNV. This review critically summarises the latest myopic CNV literature in the context of clinical experience and recommends a myopic CNV treatment algorithm.

https://bjo.bmj.com/content/bjophthalmol/99/3/289.full.pdf

Myopic choroidal neovascularisation: current concepts and update on clinical management

Intravitreal Bevacizumab (Avastin) for Myopic Choroidal Neovascularization : Six-Month Results of a Prospective Pilot Study

Pathological myopia is a major cause of irreversible vision loss and is the fourth to ninth most frequent cause of blindness in the world. Choroidal neovascularization (CNV) secondary to pathological

/pdf/myopic-maculopathy-a-review-46n7gw81lu.pdf

Myopic maculopathy: a review.

Pathologic myopia is more common in Asian adult population and the prevalence is around 9%1 which is much higher than that of 2% in the United States.2 High myopia is the seventh leading cause of legal blindness in adult Americans3 and ranks second in the blind registration of Hong Kong where the majority of the population is Chinese.4 Retinal and macular abnormalities including choroidal neovascularisation (CNV), chorioretinal atrophy, and retinal detachment are some of the ocular complications in patients with high myopia of excessive axial length.5 The estimated risk in developing CNV from pathologic myopia is about 4–10%6–8 and the natural course of subfoveal CNV is somewhat controversial but generally regarded as poor.7,9–12 In a series of Asian patients with myopic subfoveal CNV, the best corrected visual acuity (BCVA) dropped by 2.0 lines in a 3 year follow up, 5.0 lines in 5 years, and 5.7 lines in 10 years.13 Avila et al observed 70 eyes with untreated CNV from a predominantly white population with an average follow up of 41 months; 51% have stable or improved visual acuity.9

Different modalities of treatment, including direct laser photocoagulation and submacular surgery, have been proposed in the management of subfoveal CNV secondary to pathologic myopia but the outcomes were not encouraging.14–16 The one year results of the Verteporfin in Photodynamic Therapy (VIP) trial demonstrated that verteporfin treated patients had a higher chance of stabilising or improving vision in patients with subfoveal CNV secondary to pathologic myopia.17

There is a wide diversity in prevalence of fundus diseases between Asian and white eyes.19–22 The different degrees of pigmentation in the retinal pigment epithelial layers of dissimilar races may also affect the optimal treatment parameters and outcomes of treatments through diverse mechanisms.23–26 In the VIP study, 91% of patients were white and only 4% Asian.17 Whether Asian or Chinese eyes with pigmented retinal pigment epithelium layers respond differently to the standard verteporfin infusion protocol and predetermined laser energy level is not known. This prospective study investigated the treatment outcomes of PDT on myopic subfoveal CNV in the Chinese population over one and two year periods.

/pdf/photodynamic-therapy-with-verteporfin-for-subfoveal-2pcjhtdsrk.pdf

Photodynamic therapy with verteporfin for subfoveal choroidal neovascularisation of pathologic myopia in Chinese eyes: a prospective series of 1 and 2 year follow up.

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Photodynamic therapy with verteporfin for subfoveal choroidal neovascularisation of pathologic myopia in Chinese eyes: a prospective series of 1 and 2 year follow up.