Long-term efficacy and safety of anti-VEGF therapy in retinitis pigmentosa: a case report

Abstract

Background: Retinitis pigmentosa (RP), a neurodegenerative disease, is occasionally accompanied by choroidal neovascularization (CNV) and cystoid macular oedema. It is presently treated with repeated intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents. However, there are concerns regarding long-term inhibition of VEGF by the use of these agents, especially in cases involving neurodegenerative diseases, since VEGFs have a neuroprotective effect. Currently, there are no reports on the long-term safety of anti-VEGF therapy in patients with RP.

Case presentation: In this report, we describe the case of a 56-year-old female patient with CNV associated with RP who was treated with anti-VEGF therapy for 8 years. She had autosomal dominant RP with a heterozygous PRPH2 mutation (c.410G > A) and complained of metamorphopsia in her left eye. Examinations revealed CNV with serous retinal detachment. She was treated with as-needed injections for 2 years; however, she experienced a recurrence. Therefore, we switched to a bimonthly regimen that was continued for 6 years. In total, the patient received 34 injections of various types of anti-VEGFs over 8 years. No recurrences were noted during that time, and we have not detected any negative effects concerning the progression of visual field loss in comparison with the fellow eye.

Conclusions: No negative effects related to the progression of visual field loss were observed during continuous treatment with anti-VEGF agents for 8 years in our patient.

Keywords: Anti-VEGF therapy; Choroidal neovascularization; Long-term; PRPH2; Retinitis pigmentosa.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the institutional review board at Kyoto University Graduate School of Medicine, Kyoto, Japan. All study protocols adhered to the tenets of the Declaration of Helsinki. The patient provided written informed consent for the publication of the case.

Consent for publication

The patient provided written informed consent for the publication of the case.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1

Optical coherence tomography and Goldmann perimetry data before and after 8 years of anti-VEGF therapy. Horizontal B-scan images of the left eye (a, b) and right eye (e, f) immediately before (a, e) and 8 years after (b, f) anti-VEGF therapy, respectively. Subfoveal choroidal neovascularization with serous retinal detachment was present at baseline (a). Exudative changes were well controlled and the fibrovascular membrane remained after 8 years of anti-VEGF therapy (b). Goldmann perimetry results for the left eye (c, d) and right eye (g, h) before (c, g) and 8 years after (d, h) anti-VEGF therapy, respectively. The bold lines represent V-4 isopters. The peripheral visual field was present before treatment in both eyes (d, h). However, after treatment, the peripheral visual field remained only in the left eye (c). VEGF, vascular endothelial growth factor

Fig. 2

Change in the mean deviation value in both eyes after 8 years of treatment. The central visual field was assessed using the mean deviation (MD) value obtained using the Humphrey field analyser with the 10–2 SITA standard program. The MD values declined similarly in both eyes. The slope of the MD during the 8 years of treatment was − 0.68 dB/year and − 0.32 dB/year in the right eye and left eye, respectively. The results from the first examination for the right eye appear to be an outlier