Study examines long-term treatment outcomes of intravitreal bevacizumab in myopic macular neovascularization in high myopia

Visual improvements achieved after intravitreal bevacizumab injections to treat MNV were not maintained over the long term. (Image Credit: Adobe Stock/J)

A recent study¹ found that visual improvements achieved after intravitreal bevacizumab injections (Avastin, Genentech Inc.) to treat macular neovascularization (MNV) were not maintained over the long term, according to lead author Monica Ravenstijn, MD, and associates.

Ravenstijn is from the Rotterdam Ophthalmic Institute, Rotterdam Eye Hospital, and the Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.

Antivascular endothelial growth factor (anti-VEGF) agents are effective first-line therapies for myopic their effectiveness and safety to treat myopic MNV; however, the vision improvements are temporary. Development of chorioretinal atrophy around the regressed MNV lesion affects the visual acuity in the treated eye eventually.^2-6

Other findings were that better vision was achieved in eyes with higher visual acuity at baseline, smaller MNV lesions, and extrafoveal lesions.^2,4,7 In addition, higher gains in vision were seen in East-Asian patients compared with White patients after anti-VEGF treatment,⁸ but this translated to a better visual prognosis on the long-term compared with White patients was unknown.

Ravenstjn and colleagues conducted a retrospective analysis of longitudinal, clinical data from patients with high myopic MNV treated with intravitreal bevacizumab. A total of 117 eyes of 106 patients were followed from the first injection of bevacizumab out to 12 years. The primary outcome measures were change in the best-corrected visual acuity (BCVA) change during follow-up and recurrence of myopic MNV.

Data analysis

The mean (±SD) baseline BCVA improved significantly ( p < 0.001) after the first treatment from 0.56 ± 0.46 logarithm of the minimum angle of resolution (20/80) to 0.33 ± 0.33 (20/50). At 4 years (n = 86 eyes), the BCVA was 0.55 ± 0.57, p = 0.30) and decreased to 0.84 ± 0.76 (20/125) at 10 years (n = 27 eyes), the authors reported.

Of the 27 eyes (23%) evaluated at the 10-year follow-up, 53% developed MNV-related chorioretinal atrophy. The cumulative incidence of recurrent myopic MNV was 34% at 2 years and 59% at 5 years. The BCVA decreases in eyes with/without recurrent MNV were similar (p =0.58). Patchy chorioretinal atrophy (hazard ratio 3.0, p = 0.02) and subfoveal MNVs (hazard ratio 2.5, p = 0.048) were significantly associated with recurrent MNV.

“This retrospective myopic MNV study in White patients showed that the positive treatment effect of anti-VEGF injections lasted for 5 years,” the researchers said. “Lifelong treatment is not necessary for most myopic MNV: 1 to 10 injections were enough to cause regression of the MNV in 91% of cases.”

According to researchers, one of two eyes developed a recurrent myopic MNV over time, but recurrences did not worsen the course of the BCVA.

“Large prospective studies using multimodal imaging are needed to build on these findings and elude biomarkers to optimize treatment and visual outcome,” researchers concluded.

References:

1. Ravenstijn M, Klaver CCW, Yzer S. Long-term treatment outcomes after bevacizumab therapy for macular neovascularization in white patients with high myopia. Retina.2023;43:444-53; doi:10.1097/IAE.0000000000003675

2. Kasahara K, Moriyama M, Morohoshi K, et al. Six-year outcomes of intravitreal bevacizumab for choroidal neovascularization in patients with pathologic myopia. Retina.2017;37:1055–64.

3. Chhablani J, Paulose RM, Lasave AF, et al. Intravitreal bevacizumab monotherapy in myopic choroidal neovascularisation: 5-year outcomes for the PAN-AmericanCollaborative Retina Study Group. Br J Ophthalmol. 2018;102:455–9.

4. Ruiz-Moreno JM, Montero JA, Araiz J, et al. Intravitreal anti-vascular endothelial growth factor therapy for choroidal neovascularization secondary to pathologic myopia six years outcome. Retina. 2015;35:2450–6.

5. Sarao V, Veritti D, Macor S, Lanzetta P. Intravitreal bevacizumab for choroidal neovascularization due to pathologic myopia: long-term outcomes. Graefes Arch Clin Exp Ophthalmol. 2016;254:445–54.

6. Mallone F, Giustolisi R, Franzone F, et al. Ten-year outcomes of intravitreal bevacizumab for myopic choroidal neovascularization: analysis of prognostic factors. Pharmaceuticals (Basel). 2021;14:1042.

7. Onishi Y, Yokoi T, Kasahara K, et al. Five-year outcomes of intravitreal ranibizumab for choroidal neovascularization in patients with pathologic myopia. Retina. 2019;39:1289–98.

8. Holz FG, Tufail A, Leveziel N, et al. Ranibizumab in myopic choroidal neovascularization: a subgroup Analysis by ethnicity, age, and ocular characteristics in RADIANCE. Ophthalmologica. 2016;236:19–28.