Anti-VEGF drugs as the 2009 first-line therapy for choroidal neovascularization in pathologic myopia

Pathologic myopia is the second cause of choroidal neovascularization, after age-related macular degeneration (AMD), and the first cause in patients younger than 50 years. The current treatment of subfoveal myopic choroidal neovascularization (mCNV) is verteporfin photodynamic therapy, but its long-...

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Veröffentlicht in:Retina (Philadelphia, Pa.) Jg. 29; H. 8; S. 1062
1. Verfasser: Cohen, Salomon Y
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Sprache:Englisch
Veröffentlicht: United States 01.09.2009
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Abstract Pathologic myopia is the second cause of choroidal neovascularization, after age-related macular degeneration (AMD), and the first cause in patients younger than 50 years. The current treatment of subfoveal myopic choroidal neovascularization (mCNV) is verteporfin photodynamic therapy, but its long-term effectiveness has been disappointing. Antivascular endothelial growth factor (anti-VEGF) drugs are now widely used not only to treat choroidal neovascularization in AMD but also for choroidal neovascularization in other conditions. This review summarizes the data supplied by published case series studies about anti-VEGF therapy in mCNV. Analysis of the current literature allowed discussion of the optimal parameters for mCNV treatment by anti-VEGF, including the choice of anti-VEGF drug, its dose, the treatment protocol, and indications for retreatment. To date, the results of intravitreal bevacizumab or ranibizumab for mCNV have been reported in at least 14 studies, but they were all pilot, monocentric, and noncomparative case series. Nevertheless, they provided useful information on >250 patients and showed similar results, with significant improvement of visual acuity and an excellent safety profile. Shifting from one treatment to another is always difficult in the absence of prospective and controlled comparative studies. However, in 2009, intravitreal ranibizumab or bevacizumab may be considered as first-line therapy for sub- and juxtafoveal mCNV for three reasons: the safety of anti-VEGF drugs and intravitreal injection procedures; the disappointing long-term results of other therapies, including verteporfin treatment; and the excellent convergent results of anti-VEGF therapy in all pilot studies.
AbstractList Pathologic myopia is the second cause of choroidal neovascularization, after age-related macular degeneration (AMD), and the first cause in patients younger than 50 years. The current treatment of subfoveal myopic choroidal neovascularization (mCNV) is verteporfin photodynamic therapy, but its long-term effectiveness has been disappointing. Antivascular endothelial growth factor (anti-VEGF) drugs are now widely used not only to treat choroidal neovascularization in AMD but also for choroidal neovascularization in other conditions. This review summarizes the data supplied by published case series studies about anti-VEGF therapy in mCNV. Analysis of the current literature allowed discussion of the optimal parameters for mCNV treatment by anti-VEGF, including the choice of anti-VEGF drug, its dose, the treatment protocol, and indications for retreatment. To date, the results of intravitreal bevacizumab or ranibizumab for mCNV have been reported in at least 14 studies, but they were all pilot, monocentric, and noncomparative case series. Nevertheless, they provided useful information on >250 patients and showed similar results, with significant improvement of visual acuity and an excellent safety profile. Shifting from one treatment to another is always difficult in the absence of prospective and controlled comparative studies. However, in 2009, intravitreal ranibizumab or bevacizumab may be considered as first-line therapy for sub- and juxtafoveal mCNV for three reasons: the safety of anti-VEGF drugs and intravitreal injection procedures; the disappointing long-term results of other therapies, including verteporfin treatment; and the excellent convergent results of anti-VEGF therapy in all pilot studies.
Pathologic myopia is the second cause of choroidal neovascularization, after age-related macular degeneration (AMD), and the first cause in patients younger than 50 years. The current treatment of subfoveal myopic choroidal neovascularization (mCNV) is verteporfin photodynamic therapy, but its long-term effectiveness has been disappointing. Antivascular endothelial growth factor (anti-VEGF) drugs are now widely used not only to treat choroidal neovascularization in AMD but also for choroidal neovascularization in other conditions. This review summarizes the data supplied by published case series studies about anti-VEGF therapy in mCNV.BACKGROUNDPathologic myopia is the second cause of choroidal neovascularization, after age-related macular degeneration (AMD), and the first cause in patients younger than 50 years. The current treatment of subfoveal myopic choroidal neovascularization (mCNV) is verteporfin photodynamic therapy, but its long-term effectiveness has been disappointing. Antivascular endothelial growth factor (anti-VEGF) drugs are now widely used not only to treat choroidal neovascularization in AMD but also for choroidal neovascularization in other conditions. This review summarizes the data supplied by published case series studies about anti-VEGF therapy in mCNV.Analysis of the current literature allowed discussion of the optimal parameters for mCNV treatment by anti-VEGF, including the choice of anti-VEGF drug, its dose, the treatment protocol, and indications for retreatment.METHODSAnalysis of the current literature allowed discussion of the optimal parameters for mCNV treatment by anti-VEGF, including the choice of anti-VEGF drug, its dose, the treatment protocol, and indications for retreatment.To date, the results of intravitreal bevacizumab or ranibizumab for mCNV have been reported in at least 14 studies, but they were all pilot, monocentric, and noncomparative case series. Nevertheless, they provided useful information on >250 patients and showed similar results, with significant improvement of visual acuity and an excellent safety profile.RESULTSTo date, the results of intravitreal bevacizumab or ranibizumab for mCNV have been reported in at least 14 studies, but they were all pilot, monocentric, and noncomparative case series. Nevertheless, they provided useful information on >250 patients and showed similar results, with significant improvement of visual acuity and an excellent safety profile.Shifting from one treatment to another is always difficult in the absence of prospective and controlled comparative studies. However, in 2009, intravitreal ranibizumab or bevacizumab may be considered as first-line therapy for sub- and juxtafoveal mCNV for three reasons: the safety of anti-VEGF drugs and intravitreal injection procedures; the disappointing long-term results of other therapies, including verteporfin treatment; and the excellent convergent results of anti-VEGF therapy in all pilot studies.CONCLUSIONShifting from one treatment to another is always difficult in the absence of prospective and controlled comparative studies. However, in 2009, intravitreal ranibizumab or bevacizumab may be considered as first-line therapy for sub- and juxtafoveal mCNV for three reasons: the safety of anti-VEGF drugs and intravitreal injection procedures; the disappointing long-term results of other therapies, including verteporfin treatment; and the excellent convergent results of anti-VEGF therapy in all pilot studies.
Author Cohen, Salomon Y
Author_xml – sequence: 1
  givenname: Salomon Y
  surname: Cohen
  fullname: Cohen, Salomon Y
  email: sycohen@club-internet.fr
  organization: Centre Ophtalmologique d'Imagerie et de Laser, Paris, France. sycohen@club-internet.fr
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Snippet Pathologic myopia is the second cause of choroidal neovascularization, after age-related macular degeneration (AMD), and the first cause in patients younger...
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SubjectTerms Angiogenesis Inhibitors - administration & dosage
Angiogenesis Inhibitors - adverse effects
Antibodies, Monoclonal - administration & dosage
Antibodies, Monoclonal - adverse effects
Antibodies, Monoclonal, Humanized
Bevacizumab
Choroidal Neovascularization - drug therapy
Choroidal Neovascularization - etiology
Humans
Myopia, Degenerative - complications
Myopia, Degenerative - drug therapy
Ranibizumab
Treatment Outcome
Vascular Endothelial Growth Factor A - antagonists & inhibitors
Visual Acuity - drug effects
Title Anti-VEGF drugs as the 2009 first-line therapy for choroidal neovascularization in pathologic myopia
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