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PurposeTo assess the relationship of demographics, clinical characteristics and structural optical coherence tomography (OCT) findings to disease recurrence in a cohort of patients with newly diagnosed myopic choroidal neovascularisation (CNV)MethodsIn this retrospective, longitudinal study, a total of 64 participants (64 eyes) with successfully treated myopic CNV had obtained resolution of exudation after treatment (study baseline) and with 3 years of regular follow-ups. Several baseline OCT qualitative features and quantitative measurements were assessed at baseline and included in the analysis. Main outcome measures included incidence of disease recurrence and HR for demographics, clinical characteristics and OCT risk factors.ResultsAt month 36, 40 eyes (62.5%) developed disease recurrence (active CNV). Multivariate linear regression analysis revealed that final visual acuity (dependent variable) was associated with visual acuity at the first visit after complete resolution of exudation (pConclusionWe identified OCT risk factors for the disease recurrence in eyes with successfully treated myopic CNV. Assuming that disease recurrence is a sight-threatening event, our findings may help in the identification of high-risk patients and eventually ameliorate their outcome.

Quality of single optical coherence tomography angiography (OCTA) images of myopic choroidal neovascularisation (mCNV) is poorer than in averaged images, although obtaining averaged images takes much time. This study evaluated the clinical usefulness of novel denoising process for depicting mCNV. This study included 20 eyes of 20 patients with mCNV. Ten en face images taken in a 3 × 3 mm macular cube were obtained from outer-retina-to-choriocapillaris layer. Three image types were prepared for analysis; single images before and after the denoising process accomplished deep learning (single and denoising groups, respectively) and up to 10 images were averaged (averaging group). Pairwise comparisons showed vessel density, vessel length density, and fractal dimension (FD) were higher; whereas, vessel density index (VDI) was lower in single group than in denoising and averaging groups. Detectable CNV indices, contrast-to-nose ratio, and CNV diagnostic scores were higher in denoising and averaging groups than in single group. No significant differences were detected in VDI, FD, or CNV diagnostic scores between denoising and averaging groups. The denoising process can utilise single OCTA images to provide results comparable to averaged OCTA images, which is clinically useful for shortening examination times with quality similar to averaging.

Background Myopic choroidal neovascularization (CNV) is the most common sight-threatening complication associated with high myopia. The present study evaluated the efficacy and safety of the intravitreal injection of ziv-aflibercept in patients with myopic CNV. Methods This prospective interventional study was conducted on 20 eyes of 20 patients with active myopic CNV. Twelve patients were 40 years or older. This study was performed in the Ophthalmology Department of Tanta University Eye Hospital, Tanta University, Egypt. Optical coherence tomography (OCT) was performed for all patients at baseline and monthly after injection during the 6-month follow up period. The main outcome measures were changes in BCVA and CMT. The exploratory outcome measures were CNV size, IOP and the number of injections needed in each age group during the study period. Results Patients with myopic CNV younger than 40 years needed fewer injections (2.00 ± 0.76) than patients older than 40 years (2.50 ± 1.00), with no statistical significance detected between the two groups (p-value 0.246). CNV was smaller in the younger age group (p-value 0.209), best corrected visual acuity (BCVA) improved significantly in the younger and older age groups (p-values 0.001 and 0.028, respectively), and central macular thickness (CMT) decreased significantly after 6 months, from 242.88 ± 23.83 μm to 191.13 ± 13.83 μm in the younger age group and from 251.33 ± 26.60 μm to 197.08 ± 17.64 μm in the older age group (p = 0.001). No significant correlation was found between the final BCVA and either the spherical equivalent or central macular thickness after 6 months, with p-values of 0.135 and 0.145, respectively. No significant changes in IOP were detected in either group after the intravitreal injection. Conclusion Ziv-aflibercept is a highly effective and safe drug in cases of active myopic CNV; however, a larger number of patients and a longer follow-up period are needed to confirm our results. This study was retrospectively registered at clinicaltrials.gov (ID: NCT04290195) on 26-2-2020.

The current standard treatment of myopic choroidal neovascularisation (mCNV) is intravitreal injection of VEGF antagonists. This study was proposed to assess efficacy and safety of intravitreal bevacizumab (IVB) for the treatment of mCNV across a 10-year follow-up. Thirty eyes of thirty patients with treatment-naïve mCNV who underwent IVB and were followed up with for a minimum of ten years were recruited for the present retrospective cohort study. All participants were treated with three monthly IVB at baseline and then evaluated and treated under pro re nata (PRN) schedule. Outcome measures were to determine BCVA changes over years and identify the predictive factors of both final visual outcome and need for retreatment. Analysis of the main involved prognostic factors with correlations among variables is reported. Visual acuity remained stable at 10-year follow-up (p = 0.001) with the greatest improvement at 2 years (p &lt, 0.0001) in all CNV locations. Baseline BCVA correlated positively with final BCVA (β = 0.88, p &lt, 0.0001, R2: 0.75). No predictive factors for the need of additional injections were identified. Retinal and choroidal thickness significantly reduced over time but without correlation with the number of injections. CNV max height and area significantly decreased at 10 years (p &lt, 0.0001 and p = 0.003, respectively), with complete regression of mCNV lesion in 40% of subjects. Intravitreal bevacizumab resulted as long-term effective and safe therapy for mCNV with sustained results at 10 years.

PURPOSE: To develop a diagnostic algorithm in patients with pathologic myopia who present with typical symptoms or signs of myopic choroidal neovascularisation (mCNV). METHODS: Retrospective study. Patients with high myopia and suspected mCNV underwent fluorescein angiography (FFA), structural spectral-domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA). Active mCNV on one imaging modality plus clinical features were considered as the benchmark reference for the other two tests. Sensitivity was calculated for each modality individually and in combination. Morphological features were noted on SD-OCT and OCTA. RESULTS: Twenty-seven eyes of 26 patients were analysed. Sensitivity of SD-OCT or FFA alone was 85.19% (23/27 eyes). Sensitivity of OCTA was 74.07% (20/27 eyes). The sensitivity for SD-OCT combined with OCTA was 96.16% and combined with FFA was 97.80%. On OCTA, a “tight net” appearance was seen in 16 eyes (80%); a core vessel was visible in seven eyes (35%), all with active lesions. A “perilesional halo” was visible in 11 eyes (55%) of which 10 had active lesions. CONCLUSION: When combined, OCTA and SD-OCT or SD-OCT and FFA showed similar higher sensitivities than each modality alone. A tight vascular net and the combination of a perilesional halo and a visible core on OCTA may serve as biomarkers of mCNV activity.

Intravitreal injections of ranibizumab (IVR) and bevacizumab (IVB) have both been used as treatments for myopic choroidal neovascularisation. We aimed to produce a meta-analysis of published literature comparing IVR with IVB for the treatment of myopic choroidal neovascularisation, by searching electronic databases from January 1950 to March 2013. Our search produced three suitable studies that reported on 117 patients in total. The results of the meta-analysis demonstrated that the mean number of lines improvement after IVR appeared better compared with IVB [fixed effects model: SMD=0.46, 95% CI (0.09, 0.83), z =2.44, p =0.01]. The number of patients who had a greater than 3 line improvement was similar between groups [fixed effects model: RR=0.95, 95% CI (0.67, 1.32), z =0.33, p =0.74]. At follow up there was no difference in number of those who had an absence of leakage [fixed effects model: RR=1.04, 95% CI (0.93, 1.16), z =0.64, p =0.52]. There was no statistical significance between the two groups in relation to the number of injections [random effects model: SMD=−0.25, 95% CI (−1.12, 0.61), z =0.57, p =0.57]. Early evidence therefore suggests that intravitreal injections of ranibizumab are comparable to intravitreal injections of bevacizumab in the treatment of myopic choroidal neovascularisation. Both treatments result in a statistically significant increase in visual acuity with high numbers of patients maintaining stable vision. Further studies are still needed to strengthen results.

Background/aims To describe the morphological features of choroidal neovascularisation (CNV) and to report the ability of optical coherence tomography angiography (OCT-A) to detect the presence of myopic CNV by means of this new technique. Methods Myopic CNV cases were individuated from a pool of patients with pathological myopia consecutively presenting between October 2015 and March 2016. OCT-A images were assessed for classification of morphological features, and to estimate sensitivity and specificity. Results Thirty-six eyes of 28 consecutive patients with myopic CNV were included. In 4 out of 36 eyes it was not possible to classify the CNV ‘shape’, ‘core’, ‘margin’ and ‘appearance’ because the vascular network was not clearly visualised due to the poor quality of the examination. CNV shape on OCT-A was rated as circular in 9 eyes and irregular in 23 eyes. CNV core was visible in 11 eyes. CNV margin was considered as well defined in 16 eyes and poorly defined in 16 eyes. CNV appearance showed an ‘interlacing’ aspect in 16 eyes and a ‘tangled’ aspect in the other 16 eyes. A total of 11 CNVs were defined as active, 9 of which (81.8%) were interlacing, while a total of 21 were inactive, 14 of which (66.7%) were tangled. OCT-A sensitivity turned out to be 90.48% and specificity was 93.75%. Conclusions We describe the OCT-A features of myopic CNV secondary to pathological myopia and demonstrate its high sensitivity and specificity for neovascular detection. Qualitative evaluation of OCT-A characteristics may allow one to recognise different patterns, possibly corresponding to different degrees of neovascular activity.

Background Anti vascular endothelial growth factor (VEGF) therapy is an established treatment for various retinal diseases. Long-term data on injection frequencies and visual acuity (VA), however, are still rare. Methods Five-year analysis of real-life VA developments and injection patterns from 2072 patients (2577 eyes; 33 187 injections) with chronically active disease undergoing pro-re-nata treatment for age-related macular degeneration (AMD), diabetic macular oedema (DME), retinal vein occlusion (RVO) and myopic choroidal neovascularisation (CNV). Results Maximum mean VA gain in year 1 was+5.2 letters in AMD, +6.2 in DME, +10 in RVO and+7.2 in myopic CNV. Over 5 years, however, VA in patients with AMD declined. By year 5, 34% of patients with AMD had experienced VA loss of >15 letters, 56% had remained stable and 10% had gained >15 letters. Long-term VA developments in DME and RVO were more favourable with 81% of DME and 79% of patients with RVO gaining or maintaining vision at 5 years. In AMD, median injection frequency was six in year 1 and between four and five in consecutive years. In DME and RVO, median injection frequency was six in year 1 but lower compared with AMD in consecutive years. Injection frequency in DME was weakly associated with patient age (r s =0.1; p=0.03). Conclusions In AMD, the initial VA gain was not maintained long term despite higher injection numbers compared with DME, RVO and myopic CNV. The presented real-world data provide a peer-group-based estimate of VA developments and injection frequencies for counselling patients undergoing long-term anti-VEGF therapy.

Aims To investigate aqueous humour changes in vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) levels in patients with choroidal neovascularisation (CNV) secondary to pathological myopia (mCNV) before and after intravitreal ranibizumab injection (IVR). Methods This was a prospective, case–control study investigating aqueous levels of VEGF and PEDF in eyes with mCNV treated with IVR. Results Mean VEGF and PEDF levels in the aqueous humour of control patients were 25.7±4.9 pg/mL and 12.6±3.5 ng/mL, respectively. Lower levels of both VEGF (19.5±5.4 pg/mL) and PEDF (4.7±2.2 ng/mL) were found in patients with mCNV before IVR. After IVR, aqueous VEGF levels significantly reduced to 6.5±2.7 pg/mL, while PEDF levels significantly increased to 35.8±11.4 ng/mL. VEGF and PEDF levels significantly correlated with each other, and with best-corrected visual acuity and central retinal thickness. Conclusions The VEGF and PEDF levels in aqueous humour were significantly lower in the myopic group than in controls. Moreover, IVR resulted in reduced VEGF and increased PEDF levels in patients with mCNV. In mCNV, neovascularisation is associated with inappropriate VEGF and PEDF expression. A balance between VEGF and PEDF is crucial to prevent CNV development. Trial registration number NCT02175940.

Purpose To assess effects of age and baseline axial length on best-corrected visual acuity (BCVA) in patients (pts) with myopic CNV receiving intravitreal aflibercept (IVT-AFL). Methods MYRROR was a 48 week, double-masked, sham-controlled, Phase 3 multicentre study (NCT01249664). Pts were randomised 3:1 to IVT AFL or sham/IVT-AFL (sham to Week 20 [W20]; IVT-AFL from W24 to W48). Post hoc analyses assessed effects of baseline pt age and axial length on mean BCVA change at W24 and W48. Subgroups were based on median cut-offs (age: ≤62 y vs >62 y; axial length: ≤28.6 mm vs >28.6 mm). Results 121 pts were analysed (IVT-AFL, n=90 / sham/IVT-AFL, n=31). With age ≤62 y, mean BCVA changes were 13.0/14.7 letters (W24/W48) for IVT-AFL vs -0.8/ 8.1 for sham/IVT-AFL. With age >62 y, changes were 11.1/12.2 letters for IVT-AFL vs -3.6/-1.2 for sham/IVT-AFL. With axial length ≤28.6 mm, mean BCVA changes were 12.6/13.8 letters (W24/W48) for IVT-AFL vs -2.1/1.7 for sham/IVT-AFL. With axial length >28.6 mm, changes were 11.6/13.2 letters for IVT-AFL vs -2.0/7.0 for sham/IVT-AFL. Correlation coefficients based on age were -0.234 and -0.215 (W24/W48) (both P

Purpose To evaluate visual acuity outcomes in patients (pts) with myopic CNV receiving intravitreal aflibercept (IVT-AFL) or sham injection in the international, 48 week, Phase 3 MYRROR trial (NCT01249664). Methods Pts were randomised 3:1 to IVT AFL or sham/IVT-AFL (sham to Week 20; IVT-AFL from Week 24 to Week 48). We report on exploratory post hoc analyses evaluating proportions of pts achieving visual gains (ETDRS letters) and the associated time course. Results 121 pts were analysed (IVT-AFL, n=90/ sham/IVT-AFL, n=31). At Week 24, 63.3% and 38.9% of IVT-AFL pts had gained ≥10 or ≥15 letters from baseline. In the sham/IVT-AFL group, 12.9% and 9.7% had gained ≥10 or ≥15 letters from baseline. By Week 48, the proportion of IVT-AFL pts gaining ≥10 or ≥15 letters was 68.9% and 50.0%, respectively. At Week 48 in the sham/IVT-AFL group (i.e., 24 weeks after IVT-AFL initiation), 41.9% and 29.0% of pts had gained ≥10 or ≥15 letters from baseline, respectively. Ocular AEs were mainly mild and occurred at a similar rate with IVT-AFL and sham/IVT-AFL (37.4% vs 38.7%; most common, respectively: conjunctival haemorrhage [11.0%] and punctate keratitis [12.9%]). 7 (5.7%) pts had a serious AE (all IVT-AFL; only one SAE in study eye [macular hole]). No deaths were reported. Conclusion The proportion of IVT-AFL pts who gained ≥10 or ≥15 letters by Week 24 was well maintained and even slightly increased at Week 48. Clinically meaningful benefits from IVT-AFL were also observed at Week 48 in the sham/IVT-AFL group. However, the proportion of gainers did not reach the extent seen in the initial IVT-AFL group, suggesting that earlier IVT-AFL treatment should be recommended. Commercial interest

To evaluate the changes in the best-corrected visual acuity (BCVA) after 1 year and after ≥ 5 years after macular translocation for age-related macular degeneration (AMD) or myopic choroidal neovascularisation (mCNV).The medical records of 61 consecutive patients who underwent macular translocation with 360° retinotomy for AMD (35 eyes) or mCNV (26 eyes) were reviewed. Overall, 40 patients, 17 mCNV and 23 AMD, were followed for at least 5 years. BCVA and area of the Goldmann visual field (VF) measured before, 12 months after surgery, and at the final visit.In the 23 AMD eyes followed for ≥ 5 years, the mean preoperative BCVA was 1.149 ± 0.105 logMAR units, which significantly improved to 0.69 ± 0.06 logMAR units at 1 year (P0.001). This BCVA was maintained at 0.633 ± 0.083 logMAR units on their final examination. In the 17 eyes with mCNV followed for ≥ 5 years, the mean preoperative BCVA was 1.083 ± 0.119 logMAR units, which was significantly improved to 0.689 ± 0.121 logMAR units at 1 year (P = 0.001). This BCVA was maintained at 0.678 ± 0.142 logMAR units on their final examination. The area of the VF was significantly decreased at 12 months and did not change significantly thereafter.Our results show that macular translocation surgery significantly improves the BCVA and significantly decreases the VF area of eyes with mCNV or AMD after first 1 year. The BCVA and VF area do not change significantly from the values at 1 year for at least 5 years.

In this study, PDT was shown to be effective in preventing visual loss fewer than eight letters in pathologi- cal myopia in the first year when com- pared with sham treatment. 10 However, 17 They found that patients under the age of 40 had significant better visual outcome than patients over the age of 40. Their results need to be interpreted carefully, as they included both juxtafoveal and sub- foveal cases. The authors nonetheless raised the important point that the visual prognosis of CNV secondary to patholo- gical myopia was not always consistent. The angiographic features of the CNV in patients over the age of 40 had a more profuse angiographic leakage. Other inves- tigators have studied the effect of age on the visual outcome of treatment of CNV secondary to pathological myopia with PDT. Axer-Siegel et al, in a retrospective study, found that 50% of the older age group and 20% of the younger age group had visual loss of 15 letters or more, and the difference was significant; however, 8% of the younger patients in the series of Axer-Siegel et al continued to lose 15 or more letters despite treatment with PDT. 18

Limited macular translocation (LMT) is one of the treatment options for subfoveal choroidal neovascularisation (CNV) resulting from pathological myopia.1 The fundamental surgical principle involves the transposition of the foveal neurosensory retina to a new site with more healthy underlying retinal pigment epithelium.1,2 Direct laser photocoagulation is usually employed as an adjunct measure in eradicating the original CNV after the surgery. It has been observed that geometrically sizeable translocation is a prerequisite for a long term surgical success.2,3 The degree of translocation is, however, not often predictable and any ineffective displacement may render the subsequent laser photocoagulation extremely difficult or even impossible to perform.2,4 As a result, the recurrent or persistent CNV intruding the newly relocated fovea may jeopardise the final visual outcomes.4,5 Photodynamic therapy (PDT) may be considered a viable adjunct treatment option in such circumstance. A 41 year old woman with pathological myopia of −11.0 dioptres in both eyes presented with a subfoveal CNV and subretinal …