Comparison of photodynamic therapy, ranibizumab/bevacizumab or combination in the treatment of myopic choroidal neovascularisation: a 9-year-study from a single centre

Aim 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. Methods 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 (1.25mg/0.05mL)/ranibizumab (0.5mg/0.05mL) or a combination of vPDT and anti-VEGF. Outcome measures included complete regression (scarring) of CNV and best-corrected visual acuity (BCVA). Results 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 0.590.44 to 0.49 +/- 0.40 at mean follow-up of 54.63 +/- 39.46months. 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 +/- 13.56months. 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). Conclusion 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.