Short-Term Effect of Intravitreal Bevacizumab Injection for Choroidal Neovascularization Associated With Degenerative Myopia

Jeong-Wan Ryu; Hyun-Kyung Cho; Won-Ki Lee

doi:10.3341/jkos.2009.50.9.1334

Journal List > J Korean Ophthalmol Soc > v.50(9) > 1008358

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Ryu, Cho, and Lee: Short-Term Effect of Intravitreal Bevacizumab Injection for Choroidal Neovascularization Associated With Degenerative Myopia

Original Article

J Korean Ophthalmol Soc 2009;50(9):1334-1340.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.9.1334

Short-Term Effect of Intravitreal Bevacizumab Injection for Choroidal Neovascularization Associated With Degenerative Myopia

Jeong-Wan Ryu, MD, Hyun-Kyung Cho, MD, Won-Ki Lee, MD

Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Won Ki Lee, MD Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University #505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea Tel: 82-2-2258-2846, Fax: 82-2-599-7405, E-mail: wklee@catholic.ac.kr

Received 23 March 2009 Accepted 26 May 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the short-term effect of intravitreal bevacizumab injection for choroidal neovascularization associated with degenerative myopia.

Methods

In 15 eyes of 15 patients, one or two consecutive intravitreal bevacizumab injections were given. The best-corrected visual acuity (BCVA) and fundus examination were evaluated at baseline and monthly thereafter. Fluorescence angiography (FA) was performed at baseline, 1 month and 3 months after treatment. When the angiographic leakage persisted 1 month after the first injection, a second injection was administered.

Results

The mean followup period was 9.7 months. The mean logarithm of the minimum angle of resolution (LogMAR) BCVA was 0.81±0.44 at baseline, 0.64±0.41 at 3 months (p=0.005), and 0.60±0.41 (p=0.001) at the final examination. Five eyes received a single injection, while the other ten eyes had two consecutive injections. Three months after the first injection, 14 eyes (93.3%) had no angiographic leakage, and 1 eye (6.7%) showed a decrease in leakage. The mean lines of visual improvement at 3 months and at the final examination were 1.7 and 2.1 lines, respectively. No case of vision loss was observed throughout the followup period.

Conclusions

One or two consecutive intravitreal bevacizumab injections had favorable short-term effects on visual acuity stabilization and the regression of choroidal neovascularization associated with neovascular degenerative myopia.

Keywords: Bevacizumab, Choroidal neovascularization, Degenerative myopia

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Figure 1.

A 62-year-old woman visited our clinic with metamorphopsia on the left eye (Case 15). At baseline, fundus photograph shows small amount of subretinal hemorrhage at the temporally juxtafoveal area and the nasally juxtafovel area (A). Fluorescein angiography (FA) shows hyperfluorescence in the early phase and increased leakage at the late phase from the nasally and temporally myopic CNV (B, C). At 3 months after single injection of intravitreal bevacizumab, fundus photograph shows resolution of the subretinal hemorrhage with RPE change in the myopic CNV (D). FA shows no evidence of leakage from the previous myopic CNV (E, F).

Figure 2.

A 37-year-old woman visited our clinic with decreased visual acuity in the right eye (Case 2). At baseline, fundus photograph shows subretinal hemorrhage at the juxtafoveal area (A). Fluorescein angiography (FA) shows mild leakage atthe early phase and increased leakage at the late phase and (B, C). At 3 months after two consecutive injections of intravitreal bevacizumab, fundus photograph shows resolution of the retinal hemorrhage with fibrosis of the myopic CNV (D). FA shows no leakage but staining at the late phase (E, F).

Figure 3.

Showing changes in the mean logarithm of the minimal angle of resolution (logMAR) best corrected visual acuity (BCVA) compared baseline with 3 months and final followup (^∗ p=p value<0.05 was considered to be statistically significant).

Figure 4.

Change in visual acuity at final examination after initial bivacizumab injection. All thirteen dots below the line indicate eyes with improved vision. Two eyes had stable visual acuity at baseline and 3 months (logMAR=logarithm of the minimal angle of resolution).

Table 1.

Demographic data of patients with myopic choroidal neovascularization

Pt.	Age/Sex	F/U (m^∗)	Ocular past history	Spherical equivalent (AL^†:mm)	logMAR BCVA^‡			No. of injection	FA^§ leakage (Month 3)
Pt.	Age/Sex	F/U (m^∗)	Ocular past history	Spherical equivalent (AL^†:mm)	Baseline	Month 3	Final	No. of injection	FA^§ leakage (Month 3)
1	51/F	11		-17.00 (31.28)	0.9	0.9	0.7	2	No
2	37/F	10		-26.75 (32.75)	1	1	1	2	No
3	42/M	7	PRK	-2.25 (28.75)	0.2	0.2	0.1	2	Decreased
4	80/F	10	PDT×1	-1.38 (29.62)	1.4	1.4	1.4	2	No
5	77/F	8	Lens extraction	1.38 (28.74)	1	0.7	0.7	1	No
6	71/F	9	Cataract surgery	-1.00 (30.12)	0.8	0.7	0.7	1	No
7	73/F	12		-8.13 (29.78)	0.8	0.5	0.5	2	No
8	46/F	7	LASIK PDT+IVTA×1	-2.63 (28.84)	0.4	0.3	0.3	2	No
9	40/F	9		-17.75 (31.75)	0.5	0.3	0.3	2	No
10	24/M	8		-9.75 (29.67)	0.3	0	0	2	No
11	42/M	10	PDT× IVTA×1	-2.63 (27.45)	0.8	0.8	0.6	1	No
12	62/F	12	PDT×1	-9.75 (28.77)	1.7	0.9	0.9	2	No
13	65/F	15	Cataract surgery	-1.50 (28.43)	1.4	1.2	1.2	2	No
14	40/F	10	Cataract surgery	-24.5 (32.74)	0.7	0.6	0.5	1	No
15	62/F	8	Cataract surgery	0.50 (27.46)	0.3	0.1	0.1	1	No

^∗ m=month;

^† AL=axial length;

^‡ logMAR BCVA=logarithm of the minimal angle of resolution best corrected visual acuity;

^§ FA= fluorescein angiography.

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