December 03, 2013
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Visual acuity gain with anti-VEGF for pathologic myopia not maintained at 5 years

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VIENNA — Five-year results of a study evaluating the safety and efficacy of bevacizumab in eyes with choroidal neovascularization secondary to pathologic myopia showed that the mean visual gain achieved at 2 years is not maintained.

“We should now investigate the prognostic factors as we did with AMD,” Paolo Lanzetta, MD, said at the Advanced Retinal Therapy meeting.

Phase 3 trials showed efficacy of Lucentis (ranibizumab, Novartis/Genentech) and Eylea (aflibercept, Bayer HealthCare/Regeneron) in inducing significant improvement in best corrected visual acuity over a shorter study duration.

“Bevacizumab is still an off-label drug,” Lanzetta said. “In our study, we included 100 eyes of 86 patients with subfoveal CNV lesions. All of them achieved 2 years of follow-up, and we have data on 32 eyes at 5 years.”

Patients received an average of 4.1 Avastin (bevacizumab, Roche/Genentech) treatments in 2 years and 6.7 in 5 years. While central retinal thickness had a progressive, stable decrease, the BCVA improvement of 0.13 logMAR at 2 years was down to 0.05 logMAR in the eyes seen at 5 years.

“The long-term prognosis is poor,” Lanzetta said.

The development of chorioretinal atrophy was investigated as a factor for poor outcomes.

“A significant +7.82 mm² increase in [chorioretinal atrophy] was found at 2 years and doubled in 18 patients at 5 years. No correlation was found with the number of intravitreal injections,” Lanzetta said.

The long-term implications of anti-VEGF therapy on chorioretinal atrophy, which is a major cause of visual loss in many cases, need to be clarified, he said.

Disclosure: Lanzetta is consultant to Bayer, Novartis and Roche.