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Colour fundus photo of the left eye with myopic macular degeneration, atrophy and an elevated greyish lesion with associated pre-retinal haemorrhage.
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Myopia has become a big public health problem in certain parts of the world. Sight-threatening complications like choroidal neovascularisation membranes occur in up to 10% of pathological myopia, and natural history studies show a trend towards progressive visual loss. There are long-term financial and quality-of-life implications in this group of...
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Citations
... Foveal or extrafoveal location of CNV limits the use of lasers due to its potential side effects on the surrounding healthy tissue. The effectiveness of intravitreal administration of different antivascular endothelial growth factors (anti-VEGFs) is well known in the treatment of CNV of different origin [1][2][3][4]. The mechanism how intravitreal injections (IVIs) of such drugs work is complex and involves blocking of various types of VEGFs, decreased permeability of newly formed blood vessel walls, and reduced swelling of the retinal layers. ...
... Over the past decade, IVIs of anti-VEGF drugs take the leading place among the treatment modalities used for retinal diseases with increased production of VEGF [1][2][3][4]. However, only a few studies are dedicated to the side effects these drugs have on ocular tissues being exposed [5][6][7][8][9][10]. ...
Purpose. Choroidal neovascularization (CNV) is one of the most common complications of retinal diseases accompanied by elevated secretion of vascular endothelial growth factor (VEGF). Intravitreal anti-VEGFs (ranibizumab, bevacizumab, pegaptanib, and aflibercept) can suppress neovascularization, decrease vascular permeability and CNV size, and, thereby, improve visual function. The antiproliferative, apoptotic, and autophagic effect of anti-VEGF drugs on fibroblasts found in CNVs has not been yet explored. Methods. Concentration-dependent cellular effects of the four anti-VEGFs were examined in L929 fibroblasts over a 5-day period. The cell survival, mitotic and polykaryocytic indices, the level of apoptosis and autophagy, and the cellular growth kinetics were all assessed. Results. The anti-VEGFs could inhibit the survival, mitotic activity, and proliferation as well as increase the cellular heterogeneity, apoptosis, and autophagy of the fibroblasts in a dose-dependent manner. Cellular growth kinetics showed ranibizumab to be less aggressive, but three other anti-VEGFs showed higher antiproliferative and apoptotic activity and expressed negative cellular growth kinetics. Conclusions. The antiproliferative, apoptotic, and autophagic activity of anti-VEGFs upon fibroblasts may explain the cellular response and the etiology of CNV involution in vivo and serve as a good study model for CNV in vitro.
... Foveal or extrafoveal location of CNV limits the use of lasers due to its potential side effects on the surrounding healthy tissue. The effectiveness of intravitreal administration of different antivascular endothelial growth factors (anti-VEGFs) is well known in the treatment of CNV of different origin [1][2][3][4]. The mechanism how intravitreal injections (IVIs) of such drugs work is complex and involves blocking of various types of VEGFs, decreased permeability of newly formed blood vessel walls, and reduced swelling of the retinal layers. ...
... Over the past decade, IVIs of anti-VEGF drugs take the leading place among the treatment modalities used for retinal diseases with increased production of VEGF [1][2][3][4]. However, only a few studies are dedicated to the side effects these drugs have on ocular tissues being exposed [5][6][7][8][9][10]. ...
Purpose To evaluate the anti‐proliferative action of drugs that block vascular endothelial growth factor (anti‐VEGF: ranibizumab, bevacizumab, pegaptanib and aflibercept) upon fibroblast‐like cells, as in vitro model for studying their implication on fibroblast‐containing choroidal neovascular membranes (CNV).
Methods The cellular anti‐proliferative effects of the four anti‐VEGFs (cellular survival, mitotic‐ and polykaryocyte index, level of apoptosis) were evaluated over 5 days on the fibroblast‐like cell strain L929. Cellular growth‐kinetics indices (specific growth velocity (µ), population number doubling time (td) and reproduction velocity (n)) were calculated and used to reveal dose‐dependence of their anti‐proliferative activity.
Results The anti‐VEGFs could inhibit cellular survival, mitotic activity, and increase cellular heterogeneity of L929 cells in a dose‐dependent manner. The anti‐proliferative activity of the anti‐VEGFs was dose‐dependent, while the apoptosis level was proportional to the dose increase in all four cases. The cellular growth‐kinetics distinguished ranibizumab for having less aggressive anti‐proliferative action with increasing doses, which was due to compensation of cell death by proliferation; the rest of the anti‐VEGFs had anti‐proliferative and apoptotic activity prevail the cellular survival. Different concentrations of aflibercept caused insignificant effect upon the cellular mitotic index compared to controls.
Conclusion All four anti‐VEGF drugs exhibited marked anti‐proliferative and apoptotic activity upon fibroblast‐like cells in vitro. Overall, the explored effects might explain the fibroblast‐like response to anti‐VEGF drugs in vivo and be the cause for involution of CNVs.
... 11,15-21 Based on these studies, intravitreal ranibizumab appears to be effective for the treatment of myopic CNV, resulting in functional and anatomic improvements. A study done by Lai et al 19 and a case report by Kumaran et al 18 showed that a single injection of intravitreal ranibizumab is effective for the treatment of myopic choroidal neovascularization as was presented in this patient. The number of intravitreal ranibizumab injections required depends on patient characteristics, including location of myopic CNV and prior treatment. ...
We report a case of myopic choroidal neovascularization that showed improvement after a single injection of ranibizumab. A 45-year-old Chinese man with high myopia presented with sudden onset painless central scotoma of his right eye of 2 weeks' duration. There was no history of trauma. His right eye vision on presentation was 6/30 which showed no improvement with pinhole. The right fundus showed myopic maculopathy at the posterior pole with subretinal hemorrhage at the inferotemporal fovea. The optic disc was tilted with inferotemporal peripapillary atrophy. There was a myopic maculopathy appearance in the macula of the left eye. Fundus fluorescein angiography revealed choroidal neovascularization at the fovea of the right eye. A diagnosis of right eye choroidal neovascularization secondary to myopic maculopathy was made. A single intravitreal injection of ranibizumab 0.05 mL was given. Ten weeks following intravitreal injection, vision had improved to 6/7.5, and repeated fundus fluorescein angiography showed absence of choroidal neovascularization. Follow-up at 6 months showed visual acuity had normalized to 6/6 with glasses, which was maintained up to 12 months following treatment. The right fundus showed no further subretinal hemorrhage with no new lesions.
Purposes:
To update existing evidence and evaluate intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections for myopic choroidal neovascularization.
Methods:
The authors conducted comprehensive search in PubMed, EMBASE, Cochrane Library, Biosis Preview, and LILACS. Included studies were categorized by study design. Comparative studies were classified as randomized controlled trials (RCTs) and non-RCT studies, and these two types of studies were presented and meta-analyzed separately for the following comparisons: 1) anti-VEGF versus photodynamic therapy, 2) anti-VEGF monotherapy versus combination therapy with photodynamic therapy, 3) single versus 3 monthly injections followed by pro re nata (PRN) treatment, and 4) ranibizumab versus bevacizumab. Noncomparative prospective series were pooled to estimate mean visual gain, mean retinal thickness change, and the average number of anti-VEGF injections required for myopic choroidal neovascularization. Ocular and systemic adverse events were also summarized.
Results:
Literature search yielded 18 comparative studies and 83 noncomparative studies. Superiority of anti-VEGF over photodynamic therapy in a 24-month period was confirmed by 2 RCTs and 6 non-RCT studies. The influence of combined photodynamic therapy was uncertain based on two non-RCT studies. Three non-RCT studies showed that the visual outcomes of 3+PRN injections might be slightly better than 1+PRN injections within 1 year. No difference was observed between ranibizumab and bevacizumab in two RCTs and one non-RCT study. The estimated visual improvement was two lines on average. Adverse events were uncommon as reported.
Conclusion:
Accumulating evidence confirmed that anti-VEGF injections should be the first-line therapy for myopic choroidal neovascularization.
Myopic choroidal neovascularization (CNV) is one of the leading causes of visual impairment worldwide. The clinical and socioeconomic impact of myopic CNV in Asian countries is particularly significant due to rising trend in the prevalence and severity of pathological myopia. The exact pathogenesis of myopic CNV remains unclear and there is paucity of information with respect to incidence and risk factors for myopic CNV from prospective studies. Furthermore, there are no recognized measures that may prevent or delay the development of CNV in eyes with pathological myopia. Advances have been made in the diagnosis and characterization of myopic CNV over the years. Until recently, treatment modalities for myopic CNV were limited to thermal laser photocoagulation and photodynamic therapy with verteporfin, both these modalities primarily aim at prevention of further visual loss. In the last 5 years, inhibitors of vascular endothelial growth factor (VEGF) have been used successfully and may improve vision to some extent. Nevertheless, the long-term safety and efficacy of anti-VEGF agents remains unknown. Furthermore, the risk of developing chorioretinal atrophy remains the key factor in determining the final visual outcome. This review article summarizes the current literature on myopic CNV, highlighting new evolving diagnostic and treatment modalities, prognostic factors influencing visual outcome, and areas of future research.
Myopic choroidal neovascularization (CNV) is the first cause of CNV in young patients. The aim of this study was to compare the efficacy of intravitreal injections (IVT) of ranibizumab with photodynamic therapy (PDT) in this indication.
Retrospective comparative study analyzing the visual acuity (VA) outcomes of CNV myopic patients treated with either IVT or PDT.
Twenty-seven eyes of 25 patients were treated with PDT (group 1) and 18 eyes of 17 patients were treated with IVT of ranibizumab (group 2). Demographic data were similar in the two groups. The median initial VA was 20/80 for group 1 and 20/160 for group 2 (P=0.37). At 1 year, the median VA was 20/80 for group 1 (P=0.32) and 20/63 for group 2 (P=0.04). A significant improvement in VA was observed in 23.1% and in 27.3% of cases in groups 1 and 2, respectively (P=0.53). A significant VA worsening was observed in 34.6% of cases in group 1 and in 9.1% of cases in group 2 (P=0.21).
IVT of ranibizumab compared to PDT treatment showed greater efficacy in this study.
