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Myopic Choroidal Neovascularization

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Last updated: February 6th, 2022

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Summary of Evidence

Treatment of Myopic Choroidal Neovascularization

Intravitreal anti-VEGF injections

 

Ranibizumab

 

There was a significant improvement in BCVA and central macular thickness at 6 months in patients receiving intravitreal ranibizumab for myopic CNV.(REPAIR, 2013). {Tufail A, Patel PJ, Sivaprasad S, Amoaku W, Browning AC, Cole M, Gale R, George S, Lotery AJ, Majid M, McKibbin M, Menon G, Yang Y, Andrews C, Brittain C, Osborne A. Ranibizumab for the treatment of choroidal neovascularisation secondary to pathological myopia: interim analysis of the REPAIR study. Eye (Lond). 2013 Jun;27(6):709-15.}

 

Over 12 months, individualized ranibizumab treatment was effective in improving and sustaining BCVA in myopic CNV.(RADIANCE, 2013). {Wolf S, Balciuniene VJ, Laganovska G, Menchini U, Ohno-Matsui K, Sharma T, Wong TY, Silva R, Pilz S, Gekkieva M; RADIANCE Study Group. RADIANCE: a randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia. Ophthalmology. 2014 Mar;121(3):682-92.e2.}

 

Aflibercept

 

Intravitreal aflibercept 2 mg was effective for treatment of myopic CNV, with a limited number of injections given within the first 8 weeks.(MYRROR, 2015). {Ikuno Y, Ohno-Matsui K, Wong TY, Korobelnik JF, Vitti R, Li T, Stemper B, Asmus F, Zeitz O, Ishibashi T; MYRROR Investigators. Intravitreal Aflibercept Injection in Patients with Myopic Choroidal Neovascularization: The MYRROR Study. Ophthalmology. 2015 Jun;122(6):1220-7.}

 

 

Evidence

1. Background

2. Anti-VEGF treatment

2.1 Ranibizumab

Clinical Trial

2013 Tufail et.al. (REPAIR)

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2013
Clinical Trial

There was a significant improvement in BCVA and central macular thickness at 6 months in patients receiving intravitreal ranibizumab for myopic CNV. {Tufail A, Patel PJ, Sivaprasad S, Amoaku W, Browning AC, Cole M, Gale R, George S, Lotery AJ, Majid M, McKibbin M, Menon G, Yang Y, Andrews C, Brittain C, Osborne A. Ranibizumab for the treatment of choroidal neovascularisation secondary to pathological myopia: interim analysis of the REPAIR study. Eye (Lond). 2013 Jun;27(6):709-15.}

  • Clinical study of patients with myopic CNV administered intravitreal Ranibizumab then monthly PRN up to 11 months.
  • Findings (6-months):
    • Mean BCVA improved from baseline by 12.2 letters
    • Patients received a mean of 1.9 retreatments

Tufail et.al. (REPAIR)
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2.1.1 Ranibizumab vs PDT + Ranibizumab

Clinical Trial

2013 Wolf et.al. (RADIANCE)

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2013
Clinical Trial

Over 12 months, individualized ranibizumab treatment was effective in improving and sustaining BCVA in myopic CNV. {Wolf S, Balciuniene VJ, Laganovska G, Menchini U, Ohno-Matsui K, Sharma T, Wong TY, Silva R, Pilz S, Gekkieva M; RADIANCE Study Group. RADIANCE: a randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia. Ophthalmology. 2014 Mar;121(3):682-92.e2.}

  • Randomized controlled trial of intravitreal Ranibizumab vs PDT + Ranibizumab in CNV secondary to pathologic myopia (277 patients)
  • Findings (1-year):
Outcome Time period RAN (VA stabilisation) RAN (disease activity) Verteporfin + RAN from 3 months
BCVA change 3 months +10.5 +10.6 +2.2
6 months +11.9 +11.7
12 months +13.8 +14.4 +9.3
number of injections 4 2 2

Wolf et.al. (RADIANCE)
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2.2 Aflibercept

Clinical Trial

2015 Ikuno et.al. (MYRROR)

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2015
Clinical Trial

Intravitreal aflibercept 2 mg was effective for treatment of myopic CNV, with a limited number of injections given within the first 8 weeks. {Ikuno Y, Ohno-Matsui K, Wong TY, Korobelnik JF, Vitti R, Li T, Stemper B, Asmus F, Zeitz O, Ishibashi T; MYRROR Investigators. Intravitreal Aflibercept Injection in Patients with Myopic Choroidal Neovascularization: The MYRROR Study. Ophthalmology. 2015 Jun;122(6):1220-7.}

  • Randomized controlled trial of intravitreal Aflibercept vs sham (Aflibercept allowed from week 24) in myopic CNV (122 patients)
  • Findings (2-years):
Outcomes Time period AFLI Sham/AFLI
VA change (letters) 24 weeks +12.1 -2
48 weeks +13.5 +3.9
Number of injections (over 48 weeks) 2 3

Ikuno et.al. (MYRROR)
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