Predictive Factors for Visual Outcome after Treatment for Myopic Choroidal Neovascularization

Ha Na Oh; Joo Eun Lee; Hyun Woong Kim; Il Han Yun

doi:10.3341/jkos.2013.54.4.610

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Oh, Lee, Kim, and Yun: Predictive Factors for Visual Outcome after Treatment for Myopic Choroidal Neovascularization

Original Article

J Korean Ophthalmol Soc 2007;54(4):610-617.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.4.610

Predictive Factors for Visual Outcome after Treatment for Myopic Choroidal Neovascularization

Ha Na Oh, MD¹, Joo Eun Lee, MD, PhD², Hyun Woong Kim, MD, PhD¹, Il Han Yun, MD, PhD^1,

¹Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

²Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

Address reprint requests to Il Han Yun, MD, PhD Department of Ophthalmology, Inje University Busan Paik Hospital #75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea Tel: 82-51-890-6016, Fax: 82-51-890-6329, E-mail: ihyun@inje.ac.kr

Received 25 May 201210 September 2012 Accepted 23 January 2013

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 determine predictive factors associated with visual outcome after treatment for myopic choroidal neovascularization (mCNV).

Methods

Medical records of the patients who underwent photodynamic therapy (PDT), intravitreal anti-vascular endothelial growth factor (Anti-VEGF) injection, or combination therapy of PDT and Anti-VEGF for myopic CNV, and followed up for more than a year, were reviewed retrospectively. Multiple linear regression analyses were performed to evaluate the predictive factors significantly associated with the visual outcome at 1 year after the treatment.

Results

Mean best-corrected visual acuity (BCVA) of 45 eyes of 45 patients showed statistically significant improvement 1 year after the treatment with a mean of 3.5 line improvement (p < 0.01, Wilcoxon signed rank test). Age, 1-month BCVA after treatment and treatment type appeared to be associated with the 1-year visual outcome after treatment for mCNV (p = 0.033, p < 0.001, and p = 0.044, respectively, multivariate linear regression analysis).

Conclusions

Younger age (less than 40 years), better 1-month BCVA after treatment, intravitreal Anti-VEGF monotherapy were associated with improved visual outcome after treatment for mCNV. In particular, 1-month BCVA after treatment is a useful indicator to predict therapeutic response after treatment for mCNV.

Keywords: Anti-VEGF, Bevacizumab, Myopic CNV, PDT, Ranibizumab

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Figure 1.

Mean best corrected visual acuity (log MAR) changes of all eyes after the first treatment. M ean best-corrected visual acuity (BCVA) of forty five eyes of 45 patients showed statistically significant improvement at each time points after the treatment (p < 0.01, Wilcoxon signed rank test).

Figure 2.

Mean best corrected visual acuity (BCVA, log MAR) changes at 1 year after the first treatment of the groups. M ean BCVA of all groups improved significantly at 1 year after the treatment (p = 0.028, p < 0.01, p = 0.037, respectively, in group A, B and C, W ilcoxon signed rank test).

Table 1.

Demographics and Ocular Characteristics of the Study Population

Category	Value
Number of patients (eyes)	45
Age (years)	39.5 ± 12.5
≥40	23
<40	22
Gender (M:F)	10 : 35
Baseline BCVA (log MAR)	0.75 ± 0.39
Refraction of phakic eyes (diopter)	-11.38 ± 3.35
Duration of symptoms before treatment (days)	5.4 ± 2.4
CNV size before treatment (μm)	1339 ± 445
CNV location (eyes)
Subfoveal	37
Juxtafoveal	8
OCT findings
Subretinal fluid (eyes)	11
Central macular thickness (μm)	282.56 ± 65.86
Treatment type (eyes)
PDT	7
Anti-VEGF (bevacizumab / ranibizumab)	21 (19/2)
PDT + Anti-VEGF (bevacizumab / ranibizumab)	17 (5/12)

Values are presented as mean ± SD or (n).

PDT = photodynamic therapy; VEGF = vascular endothelial growth factor.

Table 2.

Results of the linear regression models for the single and multiple covariate on the 1 year BCVA (log M AR) after 1st treatment

Covariate	Univariate	Multivariate
Beta	p-value	Beta	p-value
Age	0.396	0.007	0.116	0.033
Gender	0.149	0.330	-	-
Refractive error	-0.012	0.940	-	-
Symptom duration	0.269	0.074	-	-
Baseline BCVA (log MAR)	0.440	<0.01	-0.106	0.249
1Mo BCVA after treatment	0.9483	<0.001	0.958	<0.01
1Mo CMT decrease	0.020	0.898	-	-
CNV location	-0.153	0.317	-	-
CNV size	0.313	0.036	0.026	0.754
Subretinal fluid	0.272	0.071	-	-
Treatment type	0.340	0.022	0.184	0.044

BCVA = best corrected visual acuity; log MAR = logarithm of the minimum angle of resolution.

Table 3.

Demographics of each treatment group

	PDT (Group A)	Anti-VEGF (Group B)	PDT+ Anti-VEGF (Group C)	p-value^*
Number of patients (eyes)	7	21	17	-
Mean age (years)	41	43.5	35.2	0.063
Gender (M:F)	2 : 5	2 : 19	9 : 8	0.429
Mean refractive error (diopter)	-10.8	-10.9	-11.6	0.603
CNV location (subfoveal : juxtafoveal)	7 : 0	4 : 17	6 : 11	0.391
CNV size (μm)	1291	1282	1374	0.418
Mean baseline CMT (μm)	253	284	291	0.486
Mean baseline BCVA (log MAR)	0.87 ± 0.41	0.75 ± 0.35	0.70 ± 0.43	0.401
Mean post Tx 1 year BCVA (log MAR)	0.32 ± 0.27	0.26 ± 0.25	0.52 ± 0.45	0.044

Values are presented as mean ± SD or (n).

PDT = photodynamic therapy; VEGF = vascular endothelial growth factor; BCVA = best corrected visual acuity; log MAR = logarithm of the minimum angle of resolution; CMT = central macular thickness; Tx = treatment.

^* Kruskal-Wallis and Fisher's exact test was used.

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