title: Long-term effect of intravitreal injection of anti-VEGF agent for visual acuity and chorioretinal atrophy progression in myopic choroidal neovascularization.
abstract: OBJECTIVE
  To investigate the long-term visual prognosis and progression of chorioretinal atrophy in patients with myopic choroidal neovascularization (mCNV) treated with intravitreal injections of bevacizumab.
  
  
  METHODS
  Hospital-based, retrospective, cross-sectional study. In total, 22 patients (22 eyes) with treatment-naïve mCNV who underwent intravitreal injection of bevacizumab and were followed up for more than 48 months were investigated. Visual acuity and fundus photographs before and 1, 2, 3, and 4 years after initial treatment in the clinics were compared and judged if chorioretinal atrophy (CRA) developed/enlarged or remained unchanged. The influence of clinical characteristics including age, sex, axial length, baseline visual acuity, CNV area, CNV location, and number of injections were investigated with logistic regression analysis.
  
  
  RESULTS
  Mean logarithm of the minimum angle of resolution (logMAR) improved from 0.76 to 0.52 (P < .01), 0.48 (P < .01), and 0.54 (P < .05) after 1, 2, and 3 years, respectively. The effect slightly declined to marginally non-significant levels after 4 years (logMAR, 0.59; P = .07). CRA developed or enlarged in nine cases (41 %) in 1 year, reaching 16 cases (73 %) at the final visit. Those without CRA enlargement achieved better visual improvement. None of the aforementioned patient characteristics significantly affected CRA.
  
  
  CONCLUSIONS
  Anti-VEGF therapy for mCNV is effective for vision improvement in the long term. On the other hand, development or enlargement of CRA frequently occurred, and affected visual improvement. Strategies to manage atrophy should be the next step in achieving better visual outcome upon mCNV treatment.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan. aquio@kuhp.kyoto-u.ac.jp
authors.forename: Akio
authors.initials: A
authors.lastname: Oishi
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamashiro
authors.forename: Akitaka
authors.initials: A
authors.lastname: Tsujikawa
authors.forename: Sotaro
authors.initials: S
authors.lastname: Ooto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tamura
authors.forename: Isao
authors.initials: I
authors.lastname: Nakata
authors.forename: Masahiro
authors.initials: M
authors.lastname: Miyake
authors.forename: Nagahisa
authors.initials: N
authors.lastname: Yoshimura
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000188:drug therapy*; D003317:Corneal Dystrophies, Hereditary / Q000175:diagnosis / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D047728:Myopia, Degenerative / Q000175:diagnosis / Q000188:drug therapy*; D011379:Prognosis; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity / Q000187:drug effects*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab