Is ellipsoid zone integrity essential for visual recovery in myopic neovascularization after anti-VEGF therapy?

Paolo Milani, Marco Pellegrini, Amedeo Massacesi, Stefania Moschini, Marco Setaccioli, Davide Soranna, Antonella Zambon, Ferdinando Bottoni, Fulvio Bergamini

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate functional prognostic factors and neuroretinal changes after anti-vascular endothelial growth factor (VEGF) treatment in patients with naïve, recent myopic neovascularization (mCNV), as assessed by spectral-domain optical coherence tomography (SD-OCT). Methods: Specific changes in tomographic features between baseline and final follow-up were retrospectively evaluated by two examiners independently. Imaging was obtained by a multi-modal imaging system which combines fluorescein angiography and SD-OCT. Results: Twenty-two eyes (male, six; female, 16; mean age, 65 ± 14 years) were considered. Mean follow-up was 21.5 ± 14 months. Best-corrected visual acuity (BCVA) improved from 0.38 ± 0.26 to 0.16 ± 0.20 logMAR (p < 0.001). The ellipsoid zone and the external limiting membrane (ELM) were disrupted in 21 (95.5%) and 15 (68.2%) eyes at baseline, and in 16 (72.7%) and nine (40.9%) eyes after therapy respectively. The ellipsoid zone and ELM were typically intact at lesion margins in 13 (59.1%) and 19 eyes (86.5%) respectively at baseline. The inner retina was intact in 20 eyes (91%). Six eyes (27.3%) exhibited complete regression without fibrosis. Absence of hemorrhage and integrity of lesion-adjacent ELM and of lesion-adjacent ellipsoid zone at baseline were factors for better final BCVA (p ≤ 0.05) Conclusion: Vision gain might occur despite ellipsoid zone or ELM restoration. Hemorrhage could be considered a negative prognostic factor, integrity of lesion-adjacent ELM and of lesion-adjacent ellipsoid zone as positive prognostic factors. Myopic CNV can also resolve completely without fibrosis.

Original languageEnglish
Pages (from-to)1713-1720
Number of pages8
JournalGraefe's Archive for Clinical and Experimental Ophthalmology
Volume255
Issue number9
DOIs
Publication statusPublished - Sep 1 2017

Keywords

  • Anti-VEGF
  • Ellipsoid zone
  • External limiting membrane
  • Fluorescein angiography
  • Myopia
  • Myopic neovascularization
  • Neuroretina
  • Optical coherence tomography
  • Pathologic myopia
  • SD-OCT

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

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