Myope CNV

B. Voykov; F. Ziemssen

doi:10.1055/s-0031-1281583

Klinische Monatsblätter für Augenheilkunde, Inhaltsverzeichnis

Klin Monbl Augenheilkd 2011; 228(9): 762-770
DOI: 10.1055/s-0031-1281583

Übersicht

Myope CNV

Myopic CNVB. Voykov¹ , F. Ziemssen¹

¹Department für Augenheilkunde, Eberhard-Karl-Universität Tübingen

Abstract

Zusammenfassung

Die choroidale Neovaskularisation stellt die häufigste Ursache für eine schwere Sehverschlechterung und einen Verlust der Lesefähigkeit bei (zumeist jungen) Patienten mit degenerativer Myopie dar. Die besonderen Charakteristika der CNV im Unterschied zur altersabhängigen Makuladegeneration sowie die anatomischen Besonderheiten des hochmyopen Auges haben einen entscheidenden Einfluss auf die Möglichkeiten der Basis- und Verlaufsdiagnostik. Weil die kleinen fibrovaskulären Membranen unbehandelt zu einer schnellen Schädigung der Photorezeptoren führen, ist angesichts der schlechten Spontanprognose eine zeitnahe Behandlung erforderlich. Nicht zuletzt die überlegenen funktionellen Ergebnisse der anti-VEGF-Therapie haben zu deren Stellenwert als First-line-Therapie beigetragen. Es gibt Hinweise, dass PRN-basierte Behandlungsalgorithmen eine geringere Dosierung als bei anderen Pathologien erlauben.

Abstract

Choroidal neovascularisation secondary to pathological myopia is the most common cause of severe visual impairment in myopic patients younger than 50 years old. The typical features of myopic CNV in contrast to age-related macular degeneration as well as the anatomic characteristics have an impact on the parameters of the baseline and follow-up examinations. As the usually small fibrovascular lesions show a rapid progression in the spontaneous course of the disease and lead to irreversible damage to the photoreceptors, prompt initiation of treatment is mandatory. The superior functional results of anti-VEGF drugs provide the reason for the first-line status of this treatment modality. Increasing safety data and consistent results of prospective pilot trials have proved photodynamic therapy to be inferior. There are signs that PRN-based treatment algorithms may allow for less frequent dosing than in other retinal diseases.

Schlüsselwörter

myope CNV - anti-VEGF - Bevacizumab - Ranibizumab - Photodynamische Therapie - Lacksprung

Key words

myopic CNV - anti-VEGF - bevacizumab - ranibizumab - photodynamic therapy - lacquer crack

Volltext

Referenzen

Literatur

1 Soubrane G. Choroidal neovascularization in pathologic myopia: recent developments in diagnosis and treatment. Surv Ophthalmol. 2008; 53 121-138
2 McCarty C A, Livingston P M, Taylor H R. Prevalence of myopia in adults: implications for refractive surgeons. J Refract Surg. 1997; 13 229-234
3 Grossniklaus H E, Green W R. Pathologic findings in pathologic myopia. Retina. 1992; 12 127-133
4 Ohno-Matsui K, Yoshida T, Futagami S et al. Patchy atrophy and lacquer cracks predispose to the development of choroidal neovascularisation in pathological myopia. Br J Ophthalmol. 2003; 87 570-573
5 Ohno-Matsui K, Yoshida T. Myopic choroidal neovascularization: natural course and treatment. Curr Opin Ophthalmol. 2004; 15 197-202
6 Ikuno Y, Jo Y, Hamasaki T et al. Ocular risk factors for choroidal neovascularization in pathologic myopia. Invest Ophthalmol Vis Sci. 2010; 51 3721-3725
7 Yoshida T, Ohno-Matsui K, Yasuzumi K et al. Myopic choroidal neovascularization: a 10-year follow-up. Ophthalmology. 2003; 110 1297-1305
8 Avila M P, Weiter J J, Jalkh A E et al. Natural history of choroidal neovascularization in degenerative myopia. Ophthalmology. 1984; 91 1573-1581
9 Secretan M, Kuhn D, Soubrane G et al. Long-term visual outcome of choroidal neovascularization in pathologic myopia: natural history and laser treatment. Eur J Ophthalmol. 1997; 7 307-316
10 Hampton G R, Kohen D, Bird A C. Visual prognosis of disciform degeneration in myopia. Ophthalmology. 1983; 90 923-926
11 Verteporfin in Photodynamic Therapy Study Group Photodynamic therapy of subfoveal choroidal neovascularization in pathologic myopia with verteporfin. 1-year results of a randomized clinical trial – VIP report no. 1. Ophthalmology. 2001; 108 841-852
12 Blinder K J, Blumenkranz M S, Bressler N M et al. Verteporfin therapy of subfoveal choroidal neovascularization in pathologic myopia: 2-year results of a randomized clinical trial – VIP report no. 3. Ophthalmology. 2003; 110 667-673
13 Bottoni F, Tilanus M. The natural history of juxtafoveal and subfoveal choroidal neovascularization in high myopia. Int Ophthalmol. 2001; 24 249-255
14 Kojima A, Ohno-Matsui K, Teramukai S et al. Estimation of visual outcome without treatment in patients with subfoveal choroidal neovascularization in pathologic myopia. Graefes Arch Clin Exp Ophthalmol. 2006; 244 1474-1479
15 Hayashi K, Ohno-Matsui K, Futagami S et al. Choroidal neovascularization in highly myopic eyes after cataract surgery. Jpn J Ophthalmol. 2006; 50 345-348
16 Hayashi K, Ohno-Matsui K, Yoshida T et al. Characteristics of patients with a favorable natural course of myopic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol. 2005; 243 13-19
17 Xu L, Wang Y, Li Y et al. Causes of blindness and visual impairment in urban and rural areas in Beijing: the Beijing Eye Study. Ophthalmology. 2006; 113 1134-1411
18 Curtin B J. Ocular findings and complications. In: Curtin B J, edited by The Myopias: Basic Science and Clinical Management.. Philadelphia: Harper & Row; 1985: 277-385
19 Cheng S C, Lam C S, Yap M K. Retinal thickness in myopic and non-myopic eyes. Ophthalmic Physiol Opt. 2010; 30 776-784
20 Wang G, Qiu K L, Lu X H et al. The effect of myopia on retinal nerve fibre layer measurement: a comparative study of spectral-domain optical coherence tomography and scanning laser polarimetry. Br J Ophthalmol. 2011; 95 255-260
21 Bandello F, Blinder K, Bressler N M et al. Verteporfin in Photodynamic Therapy: report no. 5. Ophthalmology. 2004; 111 2144
22 Krebs I, Binder S, Stolba U et al. Choroidal neovascularization in pathologic myopia: three-year results after photodynamic therapy. Am J Ophthalmol. 2005; 140 416-425
23 Ruiz-Moreno J M, Amat P, Montero J A et al. Photodynamic therapy to treat choroidal neovascularisation in highly myopic patients: 4 years’ outcome. Br J Ophthalmol. 2008; 92 792-794
24 Hayashi K, Ohno-Matsui K, Shimada N et al. Long-term results of photodynamic therapy for choroidal neovascularization in Japanese patients with pathologic myopia. Am J Ophthalmol. 2011; 151 137-147
25 Coutinho A M, Silva R M, Nunes S G et al. Photodynamic therapy in high myopic eyes with choroidal neovascularization: 5 years of follow-up. Retina. 2011; E-Pub
26 Chen Y S, Lin J Y, Tseng S Y et al. Photodynamic therapy for Taiwanese patients with pathologic myopia: a 2-year follow-up. Retina. 2007; 27 839-845
27 Hayashi K, Ohno-Matsui K, Shimada N et al. Intravitreal bevacizumab on myopic choroidal neovascularization that was refractory to or had recurred after photodynamic therapy. Graefes Arch Clin Exp Ophthalmol. 2009; 247 609-618
28 Kojima A, Ohno-Matsui K, Teramukai S et al. Factors associated with the development of chorioretinal atrophy around choroidal neovascularization in pathologic myopia. Graefes Arch Clin Exp Ophthalmol. 2004; 242 114-119
29 Lam D S, Chan W M, Liu D T et al. Photodynamic therapy with verteporfin for subfoveal choroidal neovascularisation of pathologic myopia in Chinese eyes: a prospective series of 1 and 2 year follow up. Br J Ophthalmol. 2004; 88 1315-1319
30 Chan W M, Lai T Y, Wong A L et al. Combined photodynamic therapy and intravitreal triamcinolone injection for the treatment of choroidal neovascularisation secondary to pathological myopia: a pilot study. Br J Ophthalmol. 2007; 91 174-179
31 Marticorena J, Gomez-Ulla F, Fernandez M et al. Combined photodynamic therapy and intravitreal triamcinolone acetonide for the treatment of myopic subfoveal choroidal neovascularization. Am J Ophthalmol. 2006; 142 335-337
32 Rishi P, Rishi E, Venkataraman A et al. Photodynamic monotherapy or combination treatment with intravitreal triamcinolone acetonide, bevacizumab or ranibizumab for choroidal neovascularization associated with pathological myopia. Indian J Ophthalmol. 2011; 59 242-246
33 Marticorena J, Gomez-Ulla F, Fernandez M et al. Combined photodynamic therapy and intravitreal triamcinolone acetonide for the treatment of myopic subfoveal choroidal neovascularization. Am J Ophthalmol. 2006; 142 335-337
34 Stellungnahme der Deutschen Ophthalmologischen Gesellschaft, der Retinologischen Gesellschaft und des Berufsverbandes der Augenärzte Deutschlands zur Therapie der chorioidalen Neovaskularisation bei pathologischer Myopie. Ophthalmol 2010 107: 494-495
35 Yoon J U, Byun Y J, Koh H J. Intravitreal anti-VEGF versus photodynamic therapy with verteporfin for treatment of myopic choroidal neovascularization. Retina. 2010; 30 418-424
36 Bennett M D, Yee W. Pegaptanib for myopic choroidal neovascularization in a young patient. Graefes Arch Clin Exp Ophthalmol. 2007; 245 903-905
37 Gharbiya M, Giustolisi R, Allievi F et al. Choroidal neovascularization in pathologic myopia: intravitreal ranibizumab versus bevacizumab – a randomized controlled trial. Am J Ophthalmol. 2010; 149 458-464
38 Wakabayashi T, Ikuno Y, Gomi F. Different dosing of intravitreal bevacizumab for choroidal neovascularization because of pathologic myopia. Retina. 2011; E-Pub
39 Scupola A, Tiberti A C, Sasso P et al. Macular functional changes evaluated with MP-1 microperimetry after intravitreal bevacizumab for subfoveal myopic choroidal neovascularization: one-year results. Retina. 2010; 30 739-747
40 Chan W M, Lai T Y, Liu D T et al. Intravitreal bevacizumab (Avastin) for myopic choroidal neovascularization: six-month results of a prospective pilot study. Ophthalmology. 2007; 114 2190-2196
41 Yodoi Y, Tsujikawa A, Nakanishi H et al. Central retinal sensitivity after intravitreal injection of bevacizumab for myopic choroidal neovascularization. Am J Ophthalmol. 2009; 147 816-24, 824
42 Moussa S, Ansari-Shahrezaei S, Smretschnig E et al. Contrast sensitivity after intravitreal antivascular endothelial growth factor therapy for myopic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol. 2010; 248 1087-1090
43 Ikuno Y, Soga K, Wakabayashi T et al. Angiographic changes after bevacizumab. Ophthalmology. 2009; 116 2263
44 Cohen S Y. Anti-VEGF drugs as the 2009 first-line therapy for choroidal neovascularization in pathologic myopia. Retina. 2009; 29 1062-1066
45 Koh A, Lim T H, Au Eong K G et al. Optimising the management of choroidal neovascularisation in Asian patients: consensus on treatment recommendations for anti-VEGF therapy. Singapore Med J. 2011; 52 232-240
46 Ness T, Paulus W. Eye and pregnancy. Ophthalmologe. 2010; 107 863-872
47 Ziemssen F, Bartz-Schmidt K U, Grisanti S. (Side) effects of VEGF inhibition. Ophthalmologe. 2006; 103 484-492
48 Ziemssen F, Heiduschka P, Peters S et al. Chances and risks of anti-VEGF therapy. Klin Monatsbl Augenheilkd. 2008; 225 770-778
49 Petrou P, Georgalas I, Giavaras G et al. Early loss of pregnancy after intravitreal bevacizumab injection. Acta Ophthalmol. 2010; 88 e136
50 Jonas J B, Tao Y, Neumaier M et al. VEGF and refractive error. Ophthalmology. 2010; 117 2234
51 Ziemssen F. Anatomische Parameter. In: Bartz-Schmidt K U, edited by Intravitreale Pharmakotherapie. Stuttgart: Schattauer GmbH; 2008: 30-35
52 Sampat K M, Garg S J. Complications of intravitreal injections. Curr Opin Ophthalmol. 2010; 21 178-183
53 Saw S M, Gazzard G, Shih-Yen E C et al. Myopia and associated pathological complications. Ophthalmic Physiol Opt. 2005; 25 381-391
54 Meyer C H, Ziemssen F, Heimann H. Intravitreal injection. Monitoring to avoid postoperative complications. Ophthalmologe. 2008; 105 143-155, 157
55 Shimada N, Ohno-Matsui K, Hayashi K et al. Macular detachment after successful intravitreal bevacizumab for myopic choroidal neovascularization. Jpn J Ophthalmol. 2011; E-Pub
56 Chan W M, Lai T Y, Liu D T et al. Intravitreal bevacizumab (Avastin) for myopic choroidal neovascularisation: 1-year results of a prospective pilot study. Br J Ophthalmol. 2009; 93 150-154
57 Ikuno Y, Sayanagi K, Soga K et al. Intravitreal bevacizumab for choroidal neovascularization attributable to pathological myopia: one-year results. Am J Ophthalmol. 2009; 147 94-100
58 Ley A M et al. Combination therapy with verteporfin PDT and ranibizumab: Twelve-month efficacy and safety results of the MONT BLANC study. Presented at AAO 2009, (Abstract PA 005)
59 Desco M C, Mataix J, Garcia-Pous M et al. Combined therapy: photodynamic therapy and bevacizumab to treat myopic neovascular membranes. One-year follow-up. Retina. 2011; 31 475-481
60 Voykov B, Gelisken F, Inhoffen W et al. Bevacizumab for choroidal neovascularization secondary to pathologic myopia: Is there a decline of the treatment efficacy after 2 years?. Graefes Arch Clin Exp Ophthalmol. 2010; 248 543-550
61 Calvo-Gonzalez C, Reche-Frutos J, Donate J et al. Intravitreal ranibizumab for myopic choroidal neovascularization: factors predictive of visual outcome and need for retreatment. Am J Ophthalmol. 2011; 151 529-534
62 Hernandez-Rojas M L, Quiroz-Mercado H, Dalma-Weiszhausz J et al. Short-term effects of intravitreal bevacizumab for subfoveal choroidal neovascularization in pathologic myopia. Retina. 2007; 27 707-712
63 Yamamoto I, Rogers A H, Reichel E et al. Intravitreal bevacizumab (Avastin) as treatment for subfoveal choroidal neovascularisation secondary to pathological myopia. Br J Ophthalmol. 2007; 91 157-160
64 Dithmar S, Schaal K B, Hoh A E et al. Intravitreal bevacizumab for choroidal neovascularization due to pathological myopia. Ophthalmologe. 2009; 106 527-530
65 Sakaguchi H, Ikuno Y, Gomi F et al. Intravitreal injection of bevacizumab for choroidal neovascularisation associated with pathological myopia. Br J Ophthalmol. 2007; 91 161-165
66 Arias L, Planas N, Prades S et al. Intravitreal bevacizumab (Avastin) for choroidal neovascularisation secondary to pathological myopia: 6-month results. Br J Ophthalmol. 2008; 92 1035-1039
67 Mandal S, Venkatesh P, Sampangi R et al. Intravitreal bevacizumab (Avastin) as primary treatment for myopic choroidal neovascularization. Eur J Ophthalmol. 2007; 17 620-626
68 Rensch F, Spandau U H, Schlichtenbrede F et al. Intravitreal bevacizumab for myopic choroidal neovascularization. Ophthalmic Surg Lasers Imaging. 2008; 39 182-185
69 Ruiz-Moreno J M, Gomez-Ulla F, Montero J A et al. Intravitreous bevacizumab to treat subfoveal choroidal neovascularization in highly myopic eyes: short-term results. Eye. 2009; 23 334-338
70 Rheaume M A, Sebag M. Intravitreal bevacizumab for the treatment of choroidal neovascularization associated with pathological myopia. Can J Ophthalmol. 2008; 43 576-580
71 Hayashi K, Ohno-Matsui K, Teramukai S et al. Comparison of visual outcome and regression pattern of myopic choroidal neovascularization after intravitreal bevacizumab or after photodynamic therapy. Am J Ophthalmol. 2009; 148 396-408
72 Ruiz-Moreno J M, Montero J A, Gomez-Ulla F et al. Intravitreal bevacizumab to treat subfoveal choroidal neovascularisation in highly myopic eyes: 1-year outcome. Br J Ophthalmol. 2009; 93 448-451
73 Ruiz-Moreno J M, Montero J A, Arias L et al. Twelve-month outcome after one intravitreal injection of bevacizumab to treat myopic choroidal neovascularization. Retina. 2010; 30 1609-1615
74 Wu P C, Chen Y J. Intravitreal injection of bevacizumab for myopic choroidal neovascularization: 1-year follow-up. Eye. 2009; 23 2042-2045
75 Baba T, Kubota-Taniai M, Kitahashi M et al. Two-year comparison of photodynamic therapy and intravitreal bevacizumab for treatment of myopic choroidal neovascularisation. Br J Ophthalmol. 2010; 94 864-870
76 Gharbiya M, Allievi F, Conflitti S et al. Intravitreal bevacizumab for treatment of myopic choroidal neovascularization: the second year of a prospective study. Clin Ter. 2010; 161 e87-e93
77 Parodi M B, Iacono P, Papayannis A et al. Laser photocoagulation, photodynamic therapy, and intravitreal bevacizumab for the treatment of juxtafoveal choroidal neovascularization secondary to pathologic myopia. Arch Ophthalmol. 2010; 128 437-442
78 Ruiz-Moreno J M, Montero J A. Intravitreal bevacizumab to treat myopic choroidal neovascularization: 2-year outcome. Graefes Arch Clin Exp Ophthalmol. 2010; 248 937-941
79 Torron C, Egea C, Ferrer E et al. Ranibizumab as treatment for myopic choroidal neovascularization. Arch Soc Esp Oftalmol. 2009; 84 507-514
80 Hefner L, Riese J, Gerding H. Results of ranibizumab treatment for choroidal neovascularization secondary to pathological myopia. Klin Monatsbl Augenheilkd. 2011; 228 284-287
81 Konstantinidis L, Mantel I, Pournaras J A et al. Intravitreal ranibizumab (Lucentis) for the treatment of myopic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol. 2009; 247 311-318
82 Lai T Y, Chan W M, Liu D T et al. Intravitreal ranibizumab for the primary treatment of choroidal neovascularization secondary to pathologic myopia. Retina. 2009; 29 750-756
83 Lalloum F, Souied E H, Bastuji-Garin S et al. Intravitreal ranibizumab for choroidal neovascularization complicating pathologic myopia. Retina. 2010; 30 399-406
84 Mones J M, Amselem L, Serrano A et al. Intravitreal ranibizumab for choroidal neovascularization secondary to pathologic myopia: 12-month results. Eye. 2009; 23 1275-1280
85 Silva R M, Ruiz-Moreno J M, Rosa P et al. Intravitreal ranibizumab for myopic choroidal neovascularization: 12-month results. Retina. 2010; 30 407-412
86 Vadala M, Pece A, Cipolla S et al. Is ranibizumab effective in stopping the loss of vision for choroidal neovascularisation in pathologic myopia? A long-term follow-up study. Br J Ophthalmol. 2011; 95 657-661

Prof. Dr. Focke Ziemssen

Eberhard Karl Universität Tübingen, Department für Augenheilkunde

Schleichstr. 12

72076 Tübingen

Telefon: ++ 49/70 71/2 98 47 61

Fax: ++ 49/70 71/29 52 15

eMail: focke.ziemssen@med.uni-tuebingen.de