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Risk factors for subretinal fibrosis after anti-VEGF treatment of myopic choroidal neovascularisation
  1. Hu Xiao1,2,
  2. Xiujuan Zhao1,
  3. Songshan Li1,
  4. Limei Sun1,
  5. Wen Xin1,2,
  6. Zhirong Wang1,
  7. Aiyuan Zhang1,
  8. Junyan Zhang3,
  9. Xiaoyan Ding1
  1. 1 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
  2. 2 The 7th Affiliated Hospital, Sun Yat-Sen University, ShenZhen, Guangdong, China
  3. 3 Statistics, Bothwin Clinical Study US, Redmond, Washington, USA
  1. Correspondence to Professor Xiaoyan Ding, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China; dingxy75{at}


Purpose To assess the incidence, clinical features and predictive risk factors of subretinal fibrosis after treatment of active myopic choroidal neovascularisation (mCNV) with anti-vascular endothelial growth factor (VEGF).

Methods This post-hoc analysis of a randomised controlled trial included a total of 54 patients with active mCNV. The clinical data at baseline, month 3 and month 12 were used. Fundus photography and optical coherence tomography at month 3 were used to determine the presence of subretinal fibrosis after anti-VEGF therapy, and its incidence was calculated. Best-corrected visual acuity (BCVA), Visual Function Questionnaire−25 score, macular integrity index (MI) and their changes were compared between eyes with and without subretinal fibrosis. A logistic regression model was used to evaluate the risk factors of subretinal fibrosis.

Results Subretinal fibrosis occurred in 22 of 54 eyes with mCNV. Patients with subretinal fibrosis achieved similar BCVA improvement in comparison with those without fibrosis at 3 and 12 months after the treatment; however, they had lower visual acuity, more subfoveal CNV (p=0.002), higher CNV thickness at baseline (p=0.016), larger CNV size (p=0.030), larger leakage area (p=0.021) and higher presence of advanced myopic maculopathy (p=0.035). Age <45 years, BCVA <60 ETDRS letters, and MI index <20 at baseline were the predictors for subretinal fibrosis occurrence in a logistic regression model.

Conclusions The incidence of subretinal fibrosis after anti-VEGF therapy was 40.7% in eyes with mCNV. Age, baseline BCVA and MI index could serve as predictive risk factors of subretinal fibrosis after anti-VEGF treatment in patients with mCNV.

  • choroid
  • retina
  • pathology
  • neovascularisation

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  • Contributors HX and XD designed this study. HX, XZ, LS, AZ and SL collected and measured data. HX and JZ analysed data. HX, WX and XD wrote this article. All authors discussed the results and commented on the manuscript.

  • Funding Supported in part by grants from the Fundamental Research Funds of State Key Laboratory of Ophthalmology, research funds of Sun Yat-sen University (15ykjc22d; Guangzhou, Guangdong, China), Science and technology Program Guangdong, China (2016A020215096; Guangzhou, Guangdong, China) and Science and Technology Programme Guangzhou, China (201803010031; Guangzhou, Guangdong, China).

  • Disclaimer The sponsors and funding organisations had no role in the design or conduct of this research.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The study followed the tenets of the Declaration of Helsinki for biomedical research and was approved by the Institutional Review Board of the Zhongshan Ophthalmic Center, Sun Yat-Sen University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data are available upon reasonable request from corresponding author,

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