Real-world Efficacy, Safety, and the Impact of Spherical Equivalent on Intravitreal Anti-VEGF Therapy in Patients Affected by Myopic Choroidal Neovascularisation

Abstract

Purpose To analyse real-world clinical outcomes and influence of the spherical equivalent (SE) on anti-vascular endothelial growth factor (VEGF) therapy in patients affected by myopic choroidal neovascularisation (mCNV).

Patients and Methods A retrospective investigation was conducted on treatment-naïve mCNV patients receiving anti-VEGF therapy at the Department of Ophthalmology, University Medical Center Mainz, Germany, between January 2018 and March 2024. Safety, functional and morphological changes in visual acuity (VA), central retinal thickness (CRT), and central retinal volume (CRV) were evaluated over a two-year period. Further, we analysed how baseline VA and CRT relate to itʼs final outcome measures. Finally, a subgroup analysis assessed the impact of SE above and below − 10 D.

Results Significant improvements in VA, CRT, and CRV were observed. VA improved from 0.5 ± 0.27 logMAR to 0.38 ± 0.31 logMAR (p = 0.005) at 6 months and remained stable at 2 years. CRT and CRV decreased from 344.4 ± 115.0 µm to 284.2 ± 45.2 µm (p < 0.001) and 0.27 ± 0.09 mm³ to 0.22 ± 0.04 mm³ (p < 0.001), respectively, four weeks after the initial injection, with stability maintained thereafter. Baseline VA correlated strongly with final VA, whereas CRT did not. No adverse events were reported. The subgroup analysis showed no significant outcome differences based on SE.

Conclusion Anti-VEGF therapy in mCNV patients proved to be safe and effective in our study with sustained improvement in functional and anatomical measures. Baseline VA strongly predicted final VA, whereas baseline and final CRT showed no association. No differences in treatment outcomes were observed as based on a varying SE.

Zusammenfassung

Hintergrund Das Ziel dieser Arbeit ist die Analyse klinischer Real-World-Behandlungsergebnisse sowie des Einflusses des sphärischen Äquivalents (SÄ) auf die Anti-VEGF-Therapie bei Patienten mit myoper choroidaler Neovaskularisation (mCNV).

Patienten und Methoden Es erfolgte eine retrospektive Untersuchung aller therapienaiven mCNV-Patienten, die in der Augenklinik und Poliklinik der Universitätsmedizin Mainz zwischen Januar 2018 und März 2024 eine Anti-VEGF-Therapie erhielten. Dabei wurden die Sicherheit sowie funktionelle und morphologische Veränderungen, einschließlich der Sehschärfe (logMAR), der zentralen Netzhautdicke (ZND) und des zentralen Netzhautvolumens (ZNV), über einen Zeitraum von 2 Jahren betrachtet sowie weiterhin der Einfluss der Ausgangswerte von logMAR und ZND auf die finalen Ergebnismaße untersucht. Zudem erfolgte eine Subgruppenanalyse, um den Einfluss eines SÄ ober- und unterhalb − 10 dpt auf die Behandlungsergebnisse zu untersuchen.

Ergebnisse Infolge der Behandlung zeigte sich nach 6 Monaten eine Verbesserung von 0,5 ± 0,27 logMAR auf 0,38 ± 0,31 logMAR (p = 0,005) sowie ein anschließend stabiler Verlauf. Die ZND und ZNV wiesen eine Reduktion 4 Wochen nach der 1. Injektion von 344,4 ± 115,0 µm auf 284,2 ± 45,2 µm (p < 0,001) sowie von 0,27 ± 0,09 mm³ auf 0,22 ± 0,04 mm³ (p < 0,001) auf und blieben weiterhin ebenfalls stabil. Der Ausgangs-logMAR korrelierte signifikant mit dem finalen logMAR, während die ZND keine Korrelation zeigte. Infolge der Behandlung traten keine unerwünschten Ereignisse ein. Weiterhin zeigten sich in der Subgruppenanalyse keine signifikanten Unterschiede der Behandlungsergebnisse in Abhängigkeit vom SÄ.

Schlussfolgerung Die Anti-VEGF-Therapie erwies sich in unserer Studie als sicher und wirksam bei Patienten mit mCNV und führte zu anhaltenden Verbesserungen der funktionellen und morphologischen Parameter. Der Ausgangs-logMAR erwies sich als starker Prädiktor für den finalen logMAR, während keine Assoziation zwischen der Ausgangs- und finalen ZND festgestellt wurde. Unterschiede in den Behandlungsergebnissen in Abhängigkeit vom SÄ wurden weiterhin nicht beobachtet.

Conclusion Box

Already known:

• Myopic choroidal neovascularisation (mCNV) occurs at a notably younger age, compared to other diseases leading to choroidal neovascularisation, such as neovascular age-related macular degeneration (nAMD).

• Less anti-VEGF injections are required in the treatment course of mCNV patients, in comparison to nAMD.

• The role of the spherical equivalent (SE) on treatment outcomes remains unclear; few studies have described real-world outcomes of an anti-VEGF therapy in mCNV patients.

Newly described:

• Baseline visual acuity can be used as strong predictor for the 2-year visual outcomes as observed in our real-world setting, while baseline CRT does not predict 2-year anatomical outcomes.

• Our findings indicate that patients receiving anti-VEGF therapy due to mCNV exhibiting spherical equivalents (SE) of < − 10 D do not show worse clinical outcomes in comparison to patients with a SE of > − 10 D.

Keywords

myopia - choroidal neovascularisation - intravitreal therapy - retina

Schlüsselwörter

Myopie - choroidale Neovaskularisation - intravitreale Therapie - Netzhaut

Publication History

Received: 18 February 2025

Accepted: 15 March 2025

Article published online:
11 June 2025

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