title: Comparison of photodynamic therapy, ranibizumab/bevacizumab or combination in the treatment of myopic choroidal neovascularisation: a 9-year-study from a single centre.
abstract: To compare treatment outcomes for myopic choroidal neovascularisation (CNV) managed with verteporfin photodynamic therapy (vPDT), intravitreal antivascular endothelial growth factor (anti-VEGF, bevacizumab/ranibizumab) agents or combination thereof.
  
  
  
  Clinical data of 79 eyes with myopic CNV examined from March 2004 to July 2013 was retrospectively reviewed. Patients were managed with vPDT, intravitreal bevacizumab (1.25 mg/0.05 mL)/ranibizumab (0.5 mg/0.05 mL) or a combination of vPDT and anti-VEGF. Outcome measures included complete regression (scarring) of CNV and best-corrected visual acuity (BCVA).
  
  
  
  Treatments provided were vPDT (n=23), anti-VEGF (n=25) (ranibizumab, n=12; bevacizumab, n=13), vPDT+anti-VEGF (n=31). Mean logMAR BCVA changed from 0.59±0.44 to 0.49±0.40 at mean follow-up of 54.63±39.46 months. Mean logMAR vision changed from 0.68±0.57, 0.54±0.48 and 0.59±0.39 at presentation to 0.59±0.53, 0.38±0.44 and 0.37±0.37 at last follow-up in PDT (p=0.4), anti-VEGF (p=0.1) and vPDT+anti-VEGF groups (p=0.0002), respectively. CNV was scarred in 64 eyes (81%) at mean 11.03±13.56 months. Most common complication was macular scar (n=64), associated with reduced (n=17) or preserved (n=47) vision. Chorioretinal atrophy attributable to vPDT was seen in five eyes (vPDT, n=3; vPDT+anti-VEGF, n=2).
  
  
  
  Combination of vPDT and intravitreal anti-VEGF (ranibizumab/bevacizumab) was associated with better visual outcomes and higher rates of regression in eyes with myopic CNV as compared with monotherapy with PDT or anti-VEGF. Larger size of CNV, and high refractive error were independent risk factors for poor visual outcomes.
authors.affiliation: The Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Pukhraj
authors.initials: P
authors.lastname: Rishi
authors.affiliation: The Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Ekta
authors.initials: E
authors.lastname: Rishi
authors.affiliation: The Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Muna
authors.initials: M
authors.lastname: Bhende
authors.affiliation: The Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Vishvesh
authors.initials: V
authors.lastname: Agarwal
authors.affiliation: The Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Chinmayi H
authors.initials: CH
authors.lastname: Vyas
authors.affiliation: The Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Valiveti
authors.affiliation: The Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Pramod
authors.initials: P
authors.lastname: Bhende
authors.affiliation: The Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Chetan
authors.initials: C
authors.lastname: Rao
authors.affiliation: The Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Susvar
authors.affiliation: The Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Parveen
authors.initials: P
authors.lastname: Sen
authors.affiliation: The Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Raman
authors.affiliation: The Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Khetan
authors.affiliation: The Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Vinata
authors.initials: V
authors.lastname: Murali
authors.affiliation: The Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Dhanashree
authors.initials: D
authors.lastname: Ratra
authors.affiliation: The Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Tarun
authors.initials: T
authors.lastname: Sharma
mesh_terms: D000328:Adult; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000068258:Bevacizumab / Q000008:administration & dosage*; D020256:Choroidal Neovascularization / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage; D058449:Intravitreal Injections; D008297:Male; D009216:Myopia / Q000150:complications* / Q000188:drug therapy; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011166:Porphyrins / Q000627:therapeutic use*; D000069579:Ranibizumab / Q000008:administration & dosage*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D000077362:Verteporfin; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D007155:Immunologic Factors; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D000068258:Bevacizumab; D000069579:Ranibizumab
keywords: Macula; Neovascularisation; Retina; Treatment Lasers; Treatment Medical