Intravitreal ranibizumab for the treatment of myopic CNV
Reviewed by Sofia Rokerya

The authors conducted a prospective study. Sixty-four patients (65 eyes) attended the 12-month follow-up examination. The mean patient age was 47.8 years. Fifty-five patients (86.0%) were females. All patients had pathologic myopia (a spherical equivalent of more than − 6.0 diopters) with a new onset of predominantly classic choroidal neovascularisation (CNV) in the macular area associated with pathologic myopia (<2 months). By localisation 19% of CNVs were juxtafoveal (n=12) and 81% subfoveal (n=52). The median presenting visual acuity was equivalent to 0.2, and the mean baseline central retinal thickness was 313μm. These were treated with intravitreal ranibizumab 0.5mg. The regime consisted of two fixed loading injections, one at baseline and the second one month later. The indication for a third and further pro re nata (PRN) injections was based on the following reinjection criteria: visual acuity (loss of one line or more), development of new macular haemorrhage on fundus examination, evidence of late leakage on fluorescein angiography) and the presence of any fluid or any increase in macular thickness of >50μm on optical coherence tomography (OCT). The primary outcome was a change in BCVA compared to baseline at six and 12 months. The secondary endpoint was the change in central retinal thickness as per OCT from baseline to six and 12 months as well as safety, neovascularisation activity on FA and the number of ranibizumab injections applied. Compared to the baseline, best corrected visual acuity (BCVA) had improved significantly at all later points in time (p=0.001). The mean baseline BCVA was 0.2 (SD 0.13). At 12 months, it was 0.4 (SD 0.21). The greatest improvement in BCVA was seen within the first three months (p=0.0001). The mean central retinal thickness analysed by OCT showed a reduction from 313μm (SD 82) to 243.5μm (SD 31; p=0.0001). CNV closure rate was 61/65 (94) with 2.3 ±0.9 injections. There was a continuous decrease in mean OCT retinal thickness over time. Throughout the follow-up period, patients received an average number of two injections of ranibizumab. Traditional treatments for myopic CNV comprises of laser photocoagulation, transpupillary 
thermotherapy (TTT) and photodynamic therapy (PDT). These have been unsatisfactory, associated with structural damage, and have not offered long-term visual acuity benefits. Anti-VEGFS offer a better outcome. Intravitreal ranibizumab was been shown to be a safe and efficacious treatment option in myopic CNV. The 
study emphasises that visual acuity improvement was swift and could be maintained throughout the treatment study period. However, limitations of this particular study include a short-term follow-up. 

Intravitreal ranibizumab for the treatment of choroidal neovascularizations associated with pathologic myopia: a prospective study.
Pasyechnikova NV, Naumenko VO, Korol AR, et al.
OPHTHALMOLOGICA
2015;233:2-7.