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Long-term outcomes of myopic choroidal neovascularisation treated with combined ranibizumab and dexamethasone characterised by multi-modal imaging

  • Retinal Disorders
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Abstract

Aim

To characterise the long-term outcomes of myopic choroidal neovascularisation (mCNV) treated with combined ranibizumab and dexamethasone, with the use of multi-modal imaging.

Methods

A retrospective study of 20 eyes with mCNV treated with intra-vitreal ranibizumab and dexamethasone on a treat-as-needed basis were followed up for a mean period of 47 months (range 19–81 months).

Results

The mean age was 55 ± 16 years, with mean refractive error of −9.0 diopters. Subfoveal mCNV was seen in 11 eyes (52 %) and the others were juxtafoveal. At the final visit, 13 patients (65 %) had improvement, while four patients (20 %) had worsening in vision. The average number of ranibizumab and dexamethasone injections required was 3 ± 1.7. There was a significant improvement in the mean visual acuity, reduction of the central retinal thickness, and an enlargement of the area of chorioretinal atrophy. The mean rate of increase in chorioretinal atrophy area was 0.05 ± 0.09 mm2/month. Disruption of the photoreceptor layer, fragmentation of the retinal pigment epithelium, and breaks in the Bruch’s membrane with a hyper-reflective lesion causing separation of the outer retinal layers were changes associated with active mCNV seen on optical coherence tomography (OCT).

Conclusion

Visual outcomes of mCNV treated with ranibizumab and dexamethasone on a treat-as-needed basis have favourable visual acuity outcomes. Using multi-modal imaging to monitor treatment response, chorioretinal atrophy, which may be related to visual function, should be used as an additional outcome measure to study the effect of combination treatment versus monotherapy.

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Contributorship

Dr Anna Tan performed the data collection, analysis, and wrote the manuscript; Dr Kelvin Teo performed the statistical analysis for the paper; Prof Ong Sze Guan provided patients and images for this paper; Dr Adrian Koh provided the scientific advice, contributed patients and images, and edited the manuscript.

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Authors and Affiliations

  1. Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore

    Anna C. S. Tan, Kelvin Teo, Ong Sze Guan & Adrian Koh

  2. Singapore Eye Research Institute, Singapore, Singapore

    Anna C. S. Tan, Kelvin Teo & Adrian Koh

  3. Duke-NUS Singapore, Singapore, Singapore

    Anna C. S. Tan

  4. Eye & Retina Surgeons, Singapore, Singapore

    Ong Sze Guan & Adrian Koh

Authors
  1. Anna C. S. Tan
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  2. Kelvin Teo
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  3. Ong Sze Guan
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  4. Adrian Koh
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Corresponding author

Correspondence to Anna C. S. Tan.

Ethics declarations

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Funding

No additional funding was received for this project.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Informed consent

A waiver of informed consent was obtained, as this was a casenote review with no identifying information released about any individual.

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Tan, A.C.S., Teo, K., Guan, O.S. et al. Long-term outcomes of myopic choroidal neovascularisation treated with combined ranibizumab and dexamethasone characterised by multi-modal imaging. Graefes Arch Clin Exp Ophthalmol 254, 1881–1888 (2016). https://doi.org/10.1007/s00417-016-3319-9

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  • DOI: https://doi.org/10.1007/s00417-016-3319-9

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