title: Long-term outcomes of myopic choroidal neovascularisation treated with combined ranibizumab and dexamethasone characterised by multi-modal imaging.
abstract: OBJECTIVE
  To characterise the long-term outcomes of myopic choroidal neovascularisation (mCNV) treated with combined ranibizumab and dexamethasone, with the use of multi-modal imaging.
  
  
  METHODS
  A retrospective study of 20 eyes with mCNV treated with intra-vitreal ranibizumab and dexamethasone on a treat-as-needed basis were followed up for a mean period of 47 months (range 19-81 months).
  
  
  RESULTS
  The mean age was 55 ± 16 years, with mean refractive error of -9.0 diopters. Subfoveal mCNV was seen in 11 eyes (52 %) and the others were juxtafoveal. At the final visit, 13 patients (65 %) had improvement, while four patients (20 %) had worsening in vision. The average number of ranibizumab and dexamethasone injections required was 3 ± 1.7. There was a significant improvement in the mean visual acuity, reduction of the central retinal thickness, and an enlargement of the area of chorioretinal atrophy. The mean rate of increase in chorioretinal atrophy area was 0.05 ± 0.09 mm2/month. Disruption of the photoreceptor layer, fragmentation of the retinal pigment epithelium, and breaks in the Bruch's membrane with a hyper-reflective lesion causing separation of the outer retinal layers were changes associated with active mCNV seen on optical coherence tomography (OCT).
  
  
  CONCLUSIONS
  Visual outcomes of mCNV treated with ranibizumab and dexamethasone on a treat-as-needed basis have favourable visual acuity outcomes. Using multi-modal imaging to monitor treatment response, chorioretinal atrophy, which may be related to visual function, should be used as an additional outcome measure to study the effect of combination treatment versus monotherapy.
authors.affiliation: Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore. annacstan@gmail.com.|Singapore Eye Research Institute, Singapore, Singapore. annacstan@gmail.com.|Duke-NUS Singapore, Singapore, Singapore. annacstan@gmail.com.
authors.forename: Anna C S
authors.initials: AC
authors.lastname: Tan
authors.affiliation: Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.|Singapore Eye Research Institute, Singapore, Singapore.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Teo
authors.affiliation: Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.|Eye & Retina Surgeons, Singapore, Singapore.
authors.forename: Ong Sze
authors.initials: OS
authors.lastname: Guan
authors.affiliation: Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.|Singapore Eye Research Institute, Singapore, Singapore.|Eye & Retina Surgeons, Singapore, Singapore.
authors.forename: Adrian
authors.initials: A
authors.lastname: Koh
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D020256:Choroidal Neovascularization / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D003907:Dexamethasone / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D047728:Myopia, Degenerative / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D000069579:Ranibizumab / Q000627:therapeutic use*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D005938:Glucocorticoids; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D003907:Dexamethasone; D000069579:Ranibizumab
keywords: Choroidal neovascularisation; Combination therapy; Multi-modal imaging; Myopia; Ranibizumab; Steroids