Intravitreal Bevacizumab Therapy for Myopic Subfoveal Choroidal Neovascularization: 2-Year Outcomes of a Prospective Case Series

Purpose To evaluate the long-term clinical outcomes of subfoveal choroidal neovascularization (CNV) secondary to pathological myopia (PM) treated with intravitreal bevacizumab injections (IVBI) on variable monthly regimen guided by fluorescein angiography (FA) and optical coherence tomography (OCT) [an as per needed basis]. Methods Eyes with subfoveal myopic CNV were treated with IVBI on an as per needed basis till the end point of CNV inactivity.All patients underwent a complete ophthalmologic examination, including visual acuity assessment on ETDRS charts, optical coherence tomography, and fluorescein angiography assessment. The protocol required monthly IVBI on the basis of persistent intraretinal or subretinal fluid detected on OCT scan and on the presence of leakage on FA.Primary outcome was the change in mean best corrected visual acuity (BCVA) and the proportion of eyes improving in BCVA by 3 lines. Secondary outcome measures was the evaluation of the agreement between FA and OCT in detecting of the CNV activity. Results 30 patients completed the scheduled visits over the 24-month follow-up. At the baseline, the mean BCVA was 0.6±0.3 (LogMAR±SD); at 3 months of follow-up, the mean BCVA improved to 0.54±0.4. Subsequently, at 12 and 24-month examination, the mean BCVA was 0.54±0.4 and 0.50±0.4, respectively. No statistically significant difference was detected in any time-point in comparison to the baseline value.At the end of the follow-up, 36.6% of cases showed a visual improvement of 3 or more lines. Thirteen eyes (43.3%) gained at least 1 line, 5 (16%) showed a BCVA stabilization and 6 eyes (20%) lost at least 1 line.Inter-rater agreement examination between FA and OCT evidenced a good correlation. During the first year of follow-up, OCT and FA provided a consensus of 89% in identification of IRF/SF on OCT and of leakage on FA (kappa=0,68). The agreement increased to 98% during the second year (kappa=0,92) .No significant ocular or systemic adverse effect was reported. The mean injection rate over 2 years was 5.26. Conclusion IVBI for PM-related subfoveal administered on an as per needed basis over 24 months of follow-up shows promise in stabilization of vision. OCT and FA showed similar proprieties in the ability to detect CNV activity and to guide the re-treatment.