Long-term effect of intravitreal injection of anti-VEGF agent for visual acuity and chorioretinal atrophy progression in myopic choroidal neovascularization.

PURPOSE: To investigate the long-term visual prognosis and progression of chorioretinal atrophy in patients with myopic choroidal neovascularization (mCNV) treated with intravitreal injections of bevacizumab.

METHODS

Hospital-based, retrospective, cross-sectional study. In total, 22 patients (22 eyes) with treatment-naïve mCNV who underwent intravitreal injection of bevacizumab and were followed up for more than 48 months were investigated. Visual acuity and fundus photographs before and 1, 2, 3, and 4 years after initial treatment in the clinics were compared and judged if chorioretinal atrophy (CRA) developed/enlarged or remained unchanged. The influence of clinical characteristics including age, sex, axial length, baseline visual acuity, CNV area, CNV location, and number of injections were investigated with logistic regression analysis.

RESULTS

Mean logarithm of the minimum angle of resolution (logMAR) improved from 0.76 to 0.52 (P < .01), 0.48 (P < .01), and 0.54 (P < .05) after 1, 2, and 3 years, respectively. The effect slightly declined to marginally non-significant levels after 4 years (logMAR, 0.59; P = .07). CRA developed or enlarged in nine cases (41 %) in 1 year, reaching 16 cases (73 %) at the final visit. Those without CRA enlargement achieved better visual improvement. None of the aforementioned patient characteristics significantly affected CRA.

CONCLUSIONS

Anti-VEGF therapy for mCNV is effective for vision improvement in the long term. On the other hand, development or enlargement of CRA frequently occurred, and affected visual improvement. Strategies to manage atrophy should be the next step in achieving better visual outcome upon mCNV treatment.