Efficacy and safety of intravitreal anti-VEGF for myopic choroidal neovascularization

To report the 24mo outcomes of vascular endothelial growth factor (VEGF) inhibitors for myopic choroidal neovascularization (mCNV) in routine clinical practice and simultaneously evaluated the real-world safety.

The patients who received intravitreal injections of VEGF inhibitors of either ranibizumab (0.5 mg) or conbercept (0.5 mg) for mCNV were analyzed from 1 January 2017 to 1 January 2022. The primary outcome variables were mean change in best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes. The secondary outcome variables included IOP changes, the period of mCNV re-treatment, and ocular adverse events.

Totally 83 patients aged 56.40±15.36y with axial length 29.67±2.09 mm were included. In visual acuity, the mean logMAR BCVA at baseline was 0.81±0.43. After the initial improvement at 1, 3, and 6mo (P<0.05), from month 12 onwards, no statistical difference compared to baseline was found. The mean CMT from 1mo onwards had a statistically significant decrease compared with baseline CMT (P<0.05). The regression model showed better baseline BCVA and thicker baseline CMT, significantly associated with the final outcomes. In univariate analysis, choosing 3+pro re nata (PRN) as the initial injection treatment regimen was associated with better BCVA at 24mo [hazard ratio (HR)=-0.65, 95%CI: -1.23, -0.07, P=0.048]. However, the difference was not significant in multivariate analysis (HR=-0.59, 95%CI: -1.21, 0.03, P=0.089). Regarding mCNV recurrence, the mean period (P=0.725) and the proportion of mCNV reactivation (P=1.00) were similar between ranibizumab and conbercept. Kaplan-Meier plot also analyzed that the median time of re-injection was not significantly different among gender, drug, and initial injection treatment regimen. No systemic adverse events related to the therapy were observed.

BCVA gains achieved by the end of our study maintain generally sustained at the 24-mo follow-up. The findings also indicate that ranibizumab and conbercept demonstrate comparable efficacy and safety profiles. Additionally, intravitreal anti-VEGF therapy using 1+PRN regimen, offers certain advantages in both efficacy and cost-effectiveness.