Results of Ranibizumab Treatment for Choroidal Neovascularization Secondary to Pathological Myopia

Purpose: Choroidal neovascularization (CNV) secondary to pathological myopia (PM) occurs in up to 10% of PM and the natural course often leads to a considerable deterioration of visual acuity. Treatment options like laser or PDT can stabilize visual acuity. Alternatives like ranibizumab are new treatment options that show very promising results. It was the aim of this analysis to evaluate the development of visual acuity and the number of injections needed in patients with myopia-associated secondary CNVs. Methods: We retrospectively analysed 10 eyes of 9 patients (7 women, 2 men, mean age: 66 years, SD8.3; range: 54-78 years) treated with ranibizumab because of CNV secondary to PM. All eyes were treatment naive. Criteria for re-treatment were loss of visual acuity and/or activity in OCT or fluorescence angiography. Results: During the mean follow-up of 10 months (SD 6.1; range: 6 to 26 months) a mean of 2.5 (SD 1.6, range: 1 to 5) injections of ranibizumab was applied. The spherical equivalent was - 12 D (SD 4.8, range - 7,5 D to - 20.5 D). Previous to the first injection mean visual acuity was logMAR 0,64 (SD 0.20) (ETDRS: 52.8; SD: 11.4) and during the follow-up a mean of 3.4 lines (ETDRS: 16.5 letters) was gained (p = 0.008). After one month visual acuity improved to log MAR 0.47 (SD 0.1, p = 0.0012) (ETDRS: 61.7; SD: 6.5), after 3 months logMAR 0.38 (SD 0.1, p = 0.012) (ETDRS: 65.8; SD: 5.6) and after 6 months up to log MAR 0.35 (SD 0.1, p = 0.008) (ETDRS 67.3; SD5.6). At the end of the follow-up visual acuity was log MAR 0.30 (SD 0.1) (ETDRS: 69.3; SD: 6.7). No patient experienced a loss of visual acuity. No ocular or systemic side effects were observed. Conclusion: According to our results treatment of CNV secondary to PM with ranibizumab leads to a substantial improvement of visual acuity. It seems that successful treatment of CNV secondary to PM needs less anti-VEGF injections than the treatment of neovascularizations due to age-related macular degeneration. Anti-VEGF seems to be a promising alternative to PDT and laser photocoagulation in myopia-related CNV.