Two different initial treatment regimens of ranibizumab in myopic choroidal neovascularization: 12-month results from a randomized controlled study

ImportanceThe optimal treatment regimen for myopic choroidal neovascularization (mCNV) is essential to understand but currently poorly studied. BackgroundTo date, there is still no consensus on the optimal dosage and frequency of anti-vascular endothelial growth factor injections in treating mCNV. DesignA prospective, single-centre, single-blind, randomized controlled study. ParticipantsAdult patients with active mCNV. MethodsPatients were randomized 1:1 to one or three doses initial ranibizumab treatments. Additional injections were administered pro re nata (prn) over 12mo. Main Outcome MeasuresNumber and frequency of injections. ResultsFifty patients participated in the study. Patients in both 1+prn or 3+prn groups experienced similar best-corrected visual acuity gain and anatomical improvement, including central retinal thickness (CRT), CNV thickness, area of CNV and area of leakage. Over 12mo, patients in the 1+prn group received fewer ranibizumab injections (2.041.22) compared with the 3+prn group (3.58 +/- 0.72, P<0.0001), but no statistic difference of the injection received was observed in the prn period. During the follow-up, 15 of 26 eyes in the 1+prn group and 10 of 24 eyes in the 3+prn group received additional injections after initial dosing (P=0.2575). Cox regression analysis showed that 1+prn, female, age>55y and CRT>300m are risk factors for retreatment. Conclusions and RelevanceThe eyes with a single loading dose achieved parallel anatomical and functional visual improvement, while required less injections over 1y. The risk factors for retreatment include 1+prn, female, older age and thick retina thickness.