Bevacizumab for treating choroidal neovascularisation secondary to pathologic myopia.

23 04 2012

Dres. Bogomil Voykov, Faik Gelisken, Werner Inhoffen, Michael Voelker, Karl Ulrich Bartz-Schmidt & Focke Ziemssen

Graefes Arch Clin Exp RES (2010) 248:543-550

Pathologic myopia is one of the main causes of visual impairment in young adults, around the world. The most important complication is choroidal neovascularisation (NVC) Since the visual acuity of the patients may decrease until 20/200 or less after ten years of follow-up.

Tried several methods to treat it, as laser photocoagulation, extraction of the membrane and foveal translocation. The study of Verteporfin Photodynamic therapy, He showed that such treatment could prevent the loss of vision in patients with CNV secondary to myopia, Although such results will lose statistical significance at the age of two.

Recent reports indicated that the intravitreo administration of anti-VEGF agents: bevacizumab, ranibizumab and pegaptanib, they can inhibit neovascularization and treat it in pathologic myopia.

The present study investigated the effects of monotherapy with intravitreo bevacizumab in patients with CNV secondary to pathologic myopia.

Patients and methods:

Studied a series of consecutive cases, all patients of the Tuebingen Ophthalmic Centre, with two years of follow-up after treatment with 1,25 mg intravitreo bevacizumab alone or in combination with Photodynamic therapy. They studied 21 eyes of 19 patients retrospectively to determine best corrected visual acuity and the thickness of the central fovea.

Follow-up of a patient in the combined group required 21 injections of bevacizumab in total, which shows the difficulty of the treatment of patients with choroidal neovascularisation secondary to myopia.

A. pictures (Photo color) and (b) (fluorescein angiography. AF) They show a choroidal neovascularisation active before starting the combination therapy of photodynamic therapy and bevacizumab. Visual acuity better corrected at this time was 0,3 LogMAR. After this treatment the patient received five injections over because activity persisted in the following 13 months.

Photographs (c) and (d) show the recurrence of choroidal neovascularization. The injection 7 It was carried out without merging with Photodynamic therapy, they needed 4 injections in the following 8 months.

Pictures E and F show still recurrence of the membrane. At this time the visual acuity had fallen to 0,8 LogMAR. It was decided to carry out a new combination therapy and recovered the visual acuity to 0,5 LogMAR and there was no activity of the membrane during the next six months.

The G and H photographs show a third recurrence treated with bevacizumab and Photodynamic therapy (beyond the follow-up period). In the following 15 months only an injection was needed and the patient still being inspected regularly.

There is a treatment generally accepted as satisfactory to treat patients with CNV secondary to pathologic myopia.

In the present study, ten eyes were treated with bevacizumab combined with Photodynamic therapy. This method showed no positive effects after 12 and 24 months.

It is interesting to note that a subgroup of five eyes that were treated for the first time showed a loss of best corrected visual acuity to the 12 months and worsened even more to the 24 months. On the other hand, the other five eyes that had been treated previously with Photodynamic therapy showed an improvement in visual acuity better corrected a year and improved even more at age two.

This is funny, Since it would be expected that a previous treatment and a more long-standing pathology should be a worse result. On the other hand, the early perception of symptoms might have allowed faster treatment of relapses.  These results deserve to be investigated in an essay with the greatest number of cases.

Recently, several studies have shown promising results in the short term treatment with bevacizumab. One of them showed marked differences in visual acuity better corrected after one year of follow-up among patients treated for the first time and those who had previously received Photodynamic therapy.

Another study showed that patients treated with a single session of photodynamic therapy had a better result in visual acuity for those who received several treatment sessions. An explanation for this difference could be atrophy coriorretiniana that develops around the membrane of NVC, Photodynamic therapy can cause side-effects on the coriocapilares, the retina and the retinal pigment epithelium.

In the present study showed a clear trend towards improvement of visual acuity better corrected in the Group of patients treated with bevacizumab for first time. In the combination therapy group, on the other hand the best corrected visual acuity continued equal after two years. Both groups cannot be compared, Since all the eyes of the monotherapy group were treated for the first time.

Yet it could not be determined which is the ideal frequency of injections intravitreo with bevacizumab to treat patients with myopic CNV. Studies with the greatest number of cases should be made to determine which is the best plan of treatment of myopic CNV.

No observed adverse effects in this study, other studies have also shown that the intravitreo bevacizumab is a safe treatment without effects on the retina cytotoxic.

Conclusions:

Despite the limitations in the design of this study, There was combination therapy is superior for treating myopic CNV, at least in terms of functional performance and frequency of injections. The results indicate that bevacizumab may be beneficial in the treatment of patients with CNV secondary to pathologic myopia.

♦ Synthesis and translation: Dr. Martin Mocorrea, editor responsible for Intramed specializing in ophthalmology.

Published: http://www.intramed.net/

Bibliography:
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Miopiamagna.blogspot.com.es [en línea] (ESP): miopiamagna.blogspot.com.es, 23 de abril de 2012 [REF. 21 April of 2012] Available on Internet: http://miopiamagna.blogspot.com.es/2012/04/10-Ene-11-miopia-bevacizumab-para.html