Anti-vascular endothelial growth factor for the management of peripapillary choroidal neovascular membrane

To explore the evidence on the use of anti-vascular endothelial growth factor (anti-VEGF) therapy for the treatment of peripapillary choroidal neovascular membrane (pCNVM).

Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched between January 2000 and December 2024 for relevant articles that used anti-VEGF therapy to treat pCNVM of any origin. This review followed PRISMA guidelines and was prospectively registered (PROSPERO registration number CRD42024551949).

Ten studies reporting on 269 eyes were included. The most common treatment strategy was pro re nata (PRN), used in 8 studies. One study used a fixed interval regimen, and another used a loading phase followed by PRN. Across all studies, the average number of anti-VEGF injections was 7 per eye over a mean follow-up duration of 34 months (range: 3-44 months). Eight studies reported improvements in best corrected visual acuity (BCVA) at final follow-up following treatment. The mean logarithm of the minimum angle of resolution (logMAR) change was 0.092, or approximately one line Snellen improvement. Two studies reported on macular thickness, and one reported on choroidal thickness after treatment, all of which noted decreased thickness at final follow-up. No significant complications were reported.

For patients with pCNVM of various aetiologies, anti-VEGF injections using any treatment strategy, including conservative management with a PRN approach, seem to be a safe and effective therapy associated with improved visual acuity.