Pilot study of ziv-aflibercept in myopic choroidal neovascularisation patients

Amin E Nawar, Heba M Shafik, Amin E Nawar, Heba M Shafik

Abstract

Background: Myopic choroidal neovascularization (CNV) is the most common sight-threatening complication associated with high myopia. The present study evaluated the efficacy and safety of the intravitreal injection of ziv-aflibercept in patients with myopic CNV.

Methods: This prospective interventional study was conducted on 20 eyes of 20 patients with active myopic CNV. Twelve patients were 40 years or older. This study was performed in the Ophthalmology Department of Tanta University Eye Hospital, Tanta University, Egypt. Optical coherence tomography (OCT) was performed for all patients at baseline and monthly after injection during the 6-month follow up period. The main outcome measures were changes in BCVA and CMT. The exploratory outcome measures were CNV size, IOP and the number of injections needed in each age group during the study period.

Results: Patients with myopic CNV younger than 40 years needed fewer injections (2.00 ± 0.76) than patients older than 40 years (2.50 ± 1.00), with no statistical significance detected between the two groups (p-value 0.246). CNV was smaller in the younger age group (p-value 0.209), best corrected visual acuity (BCVA) improved significantly in the younger and older age groups (p-values 0.001 and 0.028, respectively), and central macular thickness (CMT) decreased significantly after 6 months, from 242.88 ± 23.83 μm to 191.13 ± 13.83 μm in the younger age group and from 251.33 ± 26.60 μm to 197.08 ± 17.64 μm in the older age group (p = 0.001). No significant correlation was found between the final BCVA and either the spherical equivalent or central macular thickness after 6 months, with p-values of 0.135 and 0.145, respectively. No significant changes in IOP were detected in either group after the intravitreal injection.

Conclusion: Ziv-aflibercept is a highly effective and safe drug in cases of active myopic CNV; however, a larger number of patients and a longer follow-up period are needed to confirm our results. This study was retrospectively registered at clinicaltrials.gov (ID: NCT04290195) on 26-2-2020.

Keywords: Central macular thickness; Choroidal neovascularization; Optical coherence tomography; Pathological myopia; Ziv-aflibercept.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Correlation between the BCVA after 6 months and spherical equivalent in all eyes
Fig. 2
Fig. 2
Correlation between the final BCVA and the final CMT after 6 months in all eyes
Fig. 3
Fig. 3
Fluorescein angiography of a female patient 55 years old with left active myopic subfoveal CNV
Fig. 4
Fig. 4
OCT of the same patient showing active subfoveal CNV, the CMT is 260 um
Fig. 5
Fig. 5
a OCT after the first injection of ziv-aflibercept with reduced CMT to 226 um. b OCT after the second injection of ziv-aflibercept with reduced CMT to 213um. c OCT after the third injection of ziv-aflibercept, the CMT declined to 184 um

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