Intravitreal injection of bevacizumab or ranibizumab for the treatment of pathological myopia choroidal neovascularization_Chinese Journal of Ocular Fundus Diseases

Authors：

Yang Lin ,  Jin Xuemin , Zhou Pengyi

Department of Ophthalmology, The First Affiliated hospital of Zhengzhou University, Zhengzhou 450052, China;

Corresponding author：

Jin Xuemin, Email: 2740913223@qq.com

Keywords：

Choroidal neovascularization/therapy; Angiogenesis inhibitors/therapeutic use; Antibodies, monoclonal/therapeutic use; Myopia, degenerative/complications

DOI：

10.3760/cma.j.issn.1005-1015.2017.02.007

Video：

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Objective To compare the efficacy of intravitreal injection of ranibizumab and bevacizumab in the treatment of pathological myopia choroidal neovascularization (PM-CNV). Methods It is a retrospective case study. Seventy-nine patients (79 eyes) with PM-CNV were enrolled in this study. There were 26 males (26 eyes) and 53 females (53 eyes), with the mean age of (30.77±5.53) years. The best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscope, fundus color photography, fundus fluorescein angiography, and optical coherence tomography (OCT) were performed. BCVA was recorded as logarithm of the minimum angle of resolution (logMAR). The central retinal thickness (CMT) was measured by OCT (Cirrus HD-OCT). The eyes were divided into bevacizumab treatment group (38 eyes) and ranibizumab treatment group (41 eyes). There was no difference of the mean logMAR BCVA, intraocular pressure and CMT between two groups (t=−0.467, −1.983, 1.293;P=0.642, 0.051, 0.200). The eyes in bevacizumab treatment group were treated with bevacizumab 0.05 ml (1.25 mg), and the eyes in ranibizumab treatment group were treated with ranibizumab 0.05 ml (0.5 mg). Times of injection between two groups were compared. The changes of intraocular pressure were observed at 1, 7 days and 1 month after treatment. The changes of logMAR BCVA and CMT at 1, 3, 6, 12 and 24 months after treatment and systemic adverse reactions occur were compared. Results At the 1, 3, 6, 12 and 24 months after treatment, the mean logMAR BCVA of the bevacizumab treatment group and the ranibizumab treatment group was significantly improved than that before treatment (F=132.374,P＜0.01). There was no significant difference in the mean logMAR BCVA at different time points between the two groups (F=0.095,P=0.759). The mean CMT of the two groups was lower than that before treatment (F=151.653,P＜0.01). There was no significant difference in the mean CMT between the two groups (F=0.332,P=0.566). No retinal detachment, endophthalmitis, cataract and persistent high intraocular pressure were associated with drug, injection-related eye and systemic adverse events during follow-up. Seven eyes had conjunctiva bleeding after treatment, 11 patients (11 eyes) complained of shadow floaters after treatment. Conclusion Intravitreal injection of bevacizumab or ranibizumab can equally effectively improve the visual acuity and reduce the CMT of PM-CNV patients.

Citation： Yang Lin, Jin Xuemin, Zhou Pengyi. Intravitreal injection of bevacizumab or ranibizumab for the treatment of pathological myopia choroidal neovascularization. Chinese Journal of Ocular Fundus Diseases, 2017, 33(2): 139-143. doi: 10.3760/cma.j.issn.1005-1015.2017.02.007 Copy

1.	Zhou P, Yang L, Jin X. Ranibizumab versus bevacizumab for the treatment of idiopathic choroidal neovascularization: 2-year results[J]. Eur J Ophthalmol, 2016, 26(3): 262-267. DOI: 10.5301/ejo.5000691.
2.	占宗议, 李梓敬, 丁小燕. 病理性近视继发脉络膜新生血管诊疗现状与进展[J]. 中华眼底病杂志, 2016, 32(1): 104-107. DOI: 10.3760/cma.j.issn.1005-1015.2016.01.029.Zhan ZY, Li ZJ, Ding XY.Choroidal neovascularization secondary to pathologic myopia: a recent update on diagnosis and treatment[J]. Chin J Ocul Fundus Dis,2016, 32(1): 104-107. DOI: 10.3760/cma.j.issn.1005-1015.2016.01.029.
3.	Tah V, Orlans HO, Hyer J, et al. Anti-VEGF therapy and the retina: an update[J/OL]. J Ophthalmol, 2015, 2015: 627674[2015-08-31]. . DOI: 10.1155/2015/627674.
4.	Martin DF, Maguire MG, Fine SL, et al. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results[J]. Ophthalmology, 2012, 119(7): 1388-1398. DOI: 10.1016/j.ophtha.2012.03.053.
5.	Chin-Yee D, Eck T, Fowler S, et al. A systematic review of as needed versus treat and extend ranibizumab or bevacizumab treatment regimens for neovascular age-related macular degeneration[J/OL].Br J Ophthalmol, 2015, 2015: E306987 [2015-10-29]. . DOI: 10.1136/bjophthalmol-2015-306987. [published online ahead of print].
6.	Lai TY, Luk FO, Lee GK, et al. Long-term outcome of intravitreal anti-vascular endothelial growth factor therapy with bevacizumab or ranibizumab as primary treatment for subfoveal myopic choroidal neovascularization[J]. Eye (Lond), 2012, 26(7): 1004-1011. DOI: 10.1038/eye.2012.97.
7.	Wang E, Chen Y. Intravitreal anti-vascular endothelial growth factor for choroidal neovascularization secondary to pathologic myopia: systematic review and meta-analysis[J]. Retina, 2013, 33(7): 1375-1392. DOI: 10.1097/IAE.0b013e31827d260a.
8.	中华医学会眼科学分会眼底病学组.我国视网膜病玻璃体腔注药术质量控制标准[J]. 中华眼科杂志, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association. Quality control standard of intravitreal injection for retinopathy in China[J]. Chin J Ophthalmol, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.
9.	Cha DM, Kim TW, Heo JW, et al. Comparison of 1-year therapeutic effect of ranibizumab and bevacizumab for myopic choroidal neovascularization: a retrospective, multicenter, comparative study [J]. BMC Ophthalmol, 2014, 14: 69. DOI: 10.1186/1471-2415-14-69.
10.	El Matri L, Chebil A, Kort F. Current and emerging treatment options for myopic choroidal neovascularization[J]. Clin Ophthalmol, 2015, 9: 733-744. DOI: 10.2147/OPTH.S49437.
11.	崔丽红, 杨智, 徐丽. 玻璃体腔注射雷珠单抗治疗病理性近视脉络膜新生血管[J]. 国际眼科杂志, 2016, 16(3): 526-528. DOI: 10.3980/j.issn.1672-5123.2016.3.34.Cui LH, Yang Z, Xu L.Efficacy of intravitreal Ranibizumab injection for choroidal neovascularization secondary to pathologic myopia[J]. Int Eye Sci, 2016, 16(3): 526-528. DOI: 10.3980/j.issn.1672-5123.2016.3.34.
12.	刘李平, 宋徽, 冀垒兵, 等. 玻璃体内注射雷珠单抗治疗病理性近视黄斑部脉络膜新生血管[J]. 眼科新进展, 2016, 36(7): 667-670. DOI: 10.13389/j.cnki.rao.2016.0177.Liu LP, Song H, Ji LB, et al. Intravitreal ranibizumab injections for pathologic myopia macular choroidal neovascularization[J]. J Clin Ophthalmol, 2016, 36(7): 667-670. DOI: 10.13389/j.cnki.rao. 2016.0177.
13.	孟鰣, 魏文斌, 李燕龙, 等. 玻璃体腔注射雷珠单抗治疗病理性近视脉络膜新生血管的疗效观察[J]. 中华眼底病杂志, 2016, 32(1): 70-72. DOI: 10.3760/cma.j.issn. 1005-1015.2016.01.017.Meng L, Wei WB, Li YL, et al. Clinical efficacy of intravitreal injection of ranibizumab for choroidal neovasculization in pathological myopia choroidal neovascularization[J]. Chin J Ocul Fundus Dis, 2016, 32(1): 70-72. DOI: 10.3760/cma.j.issn.1005-1015.2016.01.017.
14.	Nguyen QD, Shah S, Tatlipinar S, et al. Bevacizumab suppresses choroidal neovascularisation caused by pathological myopia[J]. Br J Ophthalmol, 2005, 89(10): 1368-1370.
15.	Tufail A, Patel PJ, Sivaprasad S, et al. Ranibizumab for the treatment of choroidal neovascularisation secondary to pathological myopia: interim analysis of the REPAIR study[J]. Eye (Lond), 2013, 27(6): 709-715. DOI: 10.1038/eye.2013.8.
16.	Wolf S, Balciuniene VJ, Laganovska G, et al. RADIANCE: a randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia[J]. Ophthalmology, 2014, 121(3): 682-692. DOI: 10.1016/j.ophtha. 2013.10.023.
17.	Vadala M, Pece A, Cipolla S, et al. Is ranibizumab effective in stopping the loss of vision for choroidal neovascularisation in pathologic myopia? A long-term follow-up study[J]. Br J Ophthalmol, 2011, 95(5): 657-661. DOI: 10.1136/bjo.2009.174243.
18.	Pece A, Milani P, Monteleone C, et al. A randomized trial of intravitreal bevacizumab vs. ranibizumab for myopic CNV[J]. Graefe's Arch Clin Exp Ophthalmol, 2015, 253(11): 1867-1872. DOI: 10.1007/s00417-014-2886-x.
19.	Iacono P, Parodi MB, Papayannis A, et al. Intravitreal ranibizumab versus bevacizumab for treatment of myopic choroidal neovascularization[J]. Retina, 2012, 32(8): 1539-1546. DOI: 10.1097/IAE.0b013e31826956b7.
20.	Ikuno Y, Ohno-Matsui K, Wong TY, et al. Intravitreal aflibercept injection in patients with myopic choroidal neovascularization: the MYRROR Study[J]. Ophthalmology, 2015, 122(6): 1220-1227. DOI: 10.1016/j.ophtha.2015.01.025.
21.	Ng DS, Kwok AK, Tong JM, et al. Factors influencing need for retreatment and long-term visual outcome after intravitreal bevacizumab for myopic choroidal neovascularization[J]. Retina, 2015, 35(12): 2457-2468. DOI: 10.1097/IAE.0000000000000610.
22.	曾苗, 宋艳萍, 丁琴. 玻璃体腔注射康柏西普治疗病理性近视脉络膜新生血管疗效观察[J]. 中华眼底病杂志, 2016, 32(1): 17-21. DOI: 10.3760/cma.j.issn.1005-1015.2016.01.005.Zeng M, Song YP, Ding Q.Intravitreal Conbercept for treatment of choroidal neovascularization secondary to pathologic myopia[J]. Chin J Ocul Fundus Dis,2016,32(1):17-21. DOI: 10.3760/cma.j.issn.1005-1015.2016.01.005.

1. Zhou P, Yang L, Jin X. Ranibizumab versus bevacizumab for the treatment of idiopathic choroidal neovascularization: 2-year results[J]. Eur J Ophthalmol, 2016, 26(3): 262-267. DOI: 10.5301/ejo.5000691.
2. 占宗议, 李梓敬, 丁小燕. 病理性近视继发脉络膜新生血管诊疗现状与进展[J]. 中华眼底病杂志, 2016, 32(1): 104-107. DOI: 10.3760/cma.j.issn.1005-1015.2016.01.029.Zhan ZY, Li ZJ, Ding XY.Choroidal neovascularization secondary to pathologic myopia: a recent update on diagnosis and treatment[J]. Chin J Ocul Fundus Dis,2016, 32(1): 104-107. DOI: 10.3760/cma.j.issn.1005-1015.2016.01.029.
3. Tah V, Orlans HO, Hyer J, et al. Anti-VEGF therapy and the retina: an update[J/OL]. J Ophthalmol, 2015, 2015: 627674[2015-08-31]. . DOI: 10.1155/2015/627674.
4. Martin DF, Maguire MG, Fine SL, et al. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results[J]. Ophthalmology, 2012, 119(7): 1388-1398. DOI: 10.1016/j.ophtha.2012.03.053.
5. Chin-Yee D, Eck T, Fowler S, et al. A systematic review of as needed versus treat and extend ranibizumab or bevacizumab treatment regimens for neovascular age-related macular degeneration[J/OL].Br J Ophthalmol, 2015, 2015: E306987 [2015-10-29]. . DOI: 10.1136/bjophthalmol-2015-306987. [published online ahead of print].
6. Lai TY, Luk FO, Lee GK, et al. Long-term outcome of intravitreal anti-vascular endothelial growth factor therapy with bevacizumab or ranibizumab as primary treatment for subfoveal myopic choroidal neovascularization[J]. Eye (Lond), 2012, 26(7): 1004-1011. DOI: 10.1038/eye.2012.97.
7. Wang E, Chen Y. Intravitreal anti-vascular endothelial growth factor for choroidal neovascularization secondary to pathologic myopia: systematic review and meta-analysis[J]. Retina, 2013, 33(7): 1375-1392. DOI: 10.1097/IAE.0b013e31827d260a.
8. 中华医学会眼科学分会眼底病学组.我国视网膜病玻璃体腔注药术质量控制标准[J]. 中华眼科杂志, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association. Quality control standard of intravitreal injection for retinopathy in China[J]. Chin J Ophthalmol, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.
9. Cha DM, Kim TW, Heo JW, et al. Comparison of 1-year therapeutic effect of ranibizumab and bevacizumab for myopic choroidal neovascularization: a retrospective, multicenter, comparative study [J]. BMC Ophthalmol, 2014, 14: 69. DOI: 10.1186/1471-2415-14-69.
10. El Matri L, Chebil A, Kort F. Current and emerging treatment options for myopic choroidal neovascularization[J]. Clin Ophthalmol, 2015, 9: 733-744. DOI: 10.2147/OPTH.S49437.
11. 崔丽红, 杨智, 徐丽. 玻璃体腔注射雷珠单抗治疗病理性近视脉络膜新生血管[J]. 国际眼科杂志, 2016, 16(3): 526-528. DOI: 10.3980/j.issn.1672-5123.2016.3.34.Cui LH, Yang Z, Xu L.Efficacy of intravitreal Ranibizumab injection for choroidal neovascularization secondary to pathologic myopia[J]. Int Eye Sci, 2016, 16(3): 526-528. DOI: 10.3980/j.issn.1672-5123.2016.3.34.
12. 刘李平, 宋徽, 冀垒兵, 等. 玻璃体内注射雷珠单抗治疗病理性近视黄斑部脉络膜新生血管[J]. 眼科新进展, 2016, 36(7): 667-670. DOI: 10.13389/j.cnki.rao.2016.0177.Liu LP, Song H, Ji LB, et al. Intravitreal ranibizumab injections for pathologic myopia macular choroidal neovascularization[J]. J Clin Ophthalmol, 2016, 36(7): 667-670. DOI: 10.13389/j.cnki.rao. 2016.0177.
13. 孟鰣, 魏文斌, 李燕龙, 等. 玻璃体腔注射雷珠单抗治疗病理性近视脉络膜新生血管的疗效观察[J]. 中华眼底病杂志, 2016, 32(1): 70-72. DOI: 10.3760/cma.j.issn. 1005-1015.2016.01.017.Meng L, Wei WB, Li YL, et al. Clinical efficacy of intravitreal injection of ranibizumab for choroidal neovasculization in pathological myopia choroidal neovascularization[J]. Chin J Ocul Fundus Dis, 2016, 32(1): 70-72. DOI: 10.3760/cma.j.issn.1005-1015.2016.01.017.
14. Nguyen QD, Shah S, Tatlipinar S, et al. Bevacizumab suppresses choroidal neovascularisation caused by pathological myopia[J]. Br J Ophthalmol, 2005, 89(10): 1368-1370.
15. Tufail A, Patel PJ, Sivaprasad S, et al. Ranibizumab for the treatment of choroidal neovascularisation secondary to pathological myopia: interim analysis of the REPAIR study[J]. Eye (Lond), 2013, 27(6): 709-715. DOI: 10.1038/eye.2013.8.
16. Wolf S, Balciuniene VJ, Laganovska G, et al. RADIANCE: a randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia[J]. Ophthalmology, 2014, 121(3): 682-692. DOI: 10.1016/j.ophtha. 2013.10.023.
17. Vadala M, Pece A, Cipolla S, et al. Is ranibizumab effective in stopping the loss of vision for choroidal neovascularisation in pathologic myopia? A long-term follow-up study[J]. Br J Ophthalmol, 2011, 95(5): 657-661. DOI: 10.1136/bjo.2009.174243.
18. Pece A, Milani P, Monteleone C, et al. A randomized trial of intravitreal bevacizumab vs. ranibizumab for myopic CNV[J]. Graefe's Arch Clin Exp Ophthalmol, 2015, 253(11): 1867-1872. DOI: 10.1007/s00417-014-2886-x.
19. Iacono P, Parodi MB, Papayannis A, et al. Intravitreal ranibizumab versus bevacizumab for treatment of myopic choroidal neovascularization[J]. Retina, 2012, 32(8): 1539-1546. DOI: 10.1097/IAE.0b013e31826956b7.
20. Ikuno Y, Ohno-Matsui K, Wong TY, et al. Intravitreal aflibercept injection in patients with myopic choroidal neovascularization: the MYRROR Study[J]. Ophthalmology, 2015, 122(6): 1220-1227. DOI: 10.1016/j.ophtha.2015.01.025.
21. Ng DS, Kwok AK, Tong JM, et al. Factors influencing need for retreatment and long-term visual outcome after intravitreal bevacizumab for myopic choroidal neovascularization[J]. Retina, 2015, 35(12): 2457-2468. DOI: 10.1097/IAE.0000000000000610.
22. 曾苗, 宋艳萍, 丁琴. 玻璃体腔注射康柏西普治疗病理性近视脉络膜新生血管疗效观察[J]. 中华眼底病杂志, 2016, 32(1): 17-21. DOI: 10.3760/cma.j.issn.1005-1015.2016.01.005.Zeng M, Song YP, Ding Q.Intravitreal Conbercept for treatment of choroidal neovascularization secondary to pathologic myopia[J]. Chin J Ocul Fundus Dis,2016,32(1):17-21. DOI: 10.3760/cma.j.issn.1005-1015.2016.01.005.

Chinese Journal of Ocular Fundus Diseases

Intravitreal injection of bevacizumab or ranibizumab for the treatment of pathological myopia choroidal neovascularization

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