Myopic MNV-Related Complications Common Over Long-Term in Eyes Treated with Anti-VEGF

Maria Vittoria Cicinelli, MD

New findings suggest that myopic macular neovascularization (MNV) related complications are common in the long-term in patients treated with intravitreal anti-vascular endothelial growth factor (VEGF) agents.

Despite the initially successful treatment with these agents, these complications can have detrimental effects on visual acuity, according to an investigator team led by Maria Vittoria Cicinelli, MD, Università Vita-Salute San Raffaele.

“Insights into their incidence and risk factors may help for future treatments to mitigate sight-threatening outcomes,” wrote Cicinelli.

Cicinellia and colleagues aimed to identify risk factors associated with myopic MNV-related complications in patients treated with intravitreal anti-VEGF agents in a longitudinal cohort study.

A total of 313 myopic eyes with active myopic MNV and median (interquartile range; IQR) follow-up of 42 months (IQR range, 18 – 68 months) after initiation of anti-VEGF treatment. The data regarding patients’ clinical and myopic MNV-related characteristics were collected at baseline.

Then, subsequent optical coherence tomography (OCT) scans were inspected for myopic MNV-related complications. At each visit, the best-measured visual acuity (BMVA) values were retrieved by investigators.

They identified the main outcome measures as the incidence rate and hazard ratio (HR) with 95% confidence intervals (CIs) of risk factors for fibrosis and macular atrophy calculated with Kaplan-Meier curves and Cox regression models. Subsequent outcomes included the cruden incidence of macular hole and longitudinal BMVA changes.

The data report the five-year incidence of fibrosis, atrophy, and macular hole to be 34%, 26%, and 8%, respectively. The rate of fibrosis was 10.3 (95% CI, 8.25 - 12.6) per 100 person-years.

Investigators noted the risk factors were subfoveal myopic MNV location (HR, 12.7; 95% CI, 2.70 – 56.7 vs. extrafoveal; P = .001) and intraretinal fluid at baseline (HR, 1.75; 95% CI, 1.05 – 2.98; P = .03). The rate of macular atrophy was 6.5 (95% CI, 5 – 8.3) per 100 person-years.

Moreover, the identified risk factors were diffuse (HR, 2.20 vs. tessellated fundus; 95% CI, 1.13 - 5.45; P = .02) or patchy chorioretinal atrophy (HR, 3.17 vs. tessellated fundus; 95% CI, 1.32 – 7.64; P = .01) at baseline. Before baseline, the risk factors were more numerous anti-VEGF injections (HR, 1.21; 95% CI, 1.06 – 1.38 for each treatment; P = .005).

It was reported that eyes with fibrosis and macular atrophy had faster BMVA decay over follow-up. The data show twenty eyes (6%) developed macular hole, with two subtypes identified including “atrophic” and “tractional.”

The abstract, “Long-term Incidence and Risk Factors of Macular Fibrosis, Macular Atrophy, and Macular Hole in Eyes with Myopic Neovascularization,” was published in Ophthalmology.