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One-year outcomes of anti-vascular endothelial growth factor therapy in peripapillary choroidal neovascularisation
  1. Sumit Randhir Singh1,2,
  2. Adrian T Fung3,4,5,
  3. Samantha Fraser-Bell6,
  4. Marco Lupidi7,
  5. Sashwanthi Mohan8,
  6. Pierre-Henry Gabrielle9,10,
  7. Dinah Zur11,
  8. Matias Iglicki12,
  9. Paula M López-Corell13,
  10. Roberto Gallego-Pinazo14,
  11. Cláudia Farinha15,16,
  12. Luiz H Lima17,
  13. Ahmad M Mansour18,
  14. Antonio Marcello Casella19,
  15. Lihteh Wu20,
  16. Rufino Silva15,16,
  17. Sami H Uwaydat21,
  18. Vishal Govindahari1,22,
  19. Jose Fernando Arevalo23,
  20. Jay Chhablani1
  1. 1Smt Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
  2. 2Retina and Uveitis Department, GMR Varalakshmi Campus, LV Prasad Eye Institute, Hanumanthawaka Junction, Visakhapatnam, Andhra Pradesh, India
  3. 3Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia
  4. 4Save Sight Institute, Sydney Eye Hospital, University of Sydney, Sydney, New South Wales, Australia
  5. 5Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
  6. 6Department of Ophthalmology, Sydney University, Sydney, New South Wales, Australia
  7. 7Department of Ophthalmology, University of Perugia, Perugia, Italy
  8. 8Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, Telangana, India
  9. 9Ophthalmology, Centre Hospitalier Universitaire de Dijon, Dijon, France
  10. 10Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, INRA Centre de Dijon, Dijon, France
  11. 11Division of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
  12. 12Private Retina Service, University of Buenos Aires, Buenos Aires, Argentina
  13. 13Department of Ophthalmology, University and Polytechnic Hospital La Fe, Valencia, Spain
  14. 14Hospital Universitario y Politécnico La Fe, Valencia, Spain
  15. 15Ophthalmology Department, Coimbra University Hospital Center, Coimbra, Portugal
  16. 16Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
  17. 17Ophthalmology, Federal University of Sao Paulo, São Paulo, Brazil
  18. 18Deaprtment of Ophthalmology, American University of Beirut, Beirut, Lebanon
  19. 19Ophthalmology, Universidade Estadual de Londrina, Londrina, Brazil
  20. 20Vitreo-retinal Department, Instituto de Cirugia Ocular, San Jose, Costa Rica
  21. 21University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  22. 22Retina and Uveitis Service, L V Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, India
  23. 23Retina Division, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Jay Chhablani, Smt Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, AP 34, India; jay.chhablani{at}gmail.com

Abstract

Purpose To report the visual and anatomical outcomes in eyes with peripapillary choroidal neovascularisation (CNV) through 12 months.

Methods This was a multicentre, retrospective, interventional case series which included treatment-naïve cases of peripapillary choroidal neovascular membrane (CNVM) with a minimum follow-up of 12 months. Multimodal imaging which comprised optical coherence tomography (OCT), fluorescein angiography and/or indocyanine green angiography was performed at baseline and follow-up visits. OCT parameters included central macular thickness (CMT), subfoveal choroidal thickness (SFCT) and retinal and choroidal thickness at site of CNV. Patients were treated with anti-vascular endothelial growth factors (VEGF) on pro re nata protocol, photodynamic therapy, laser photocoagulation or a combination. Main outcome measures were change in best corrected visual acuity (BCVA) and OCT parameters.

Results A total of 77 eyes (74 patients; mean age: 61.9±21.8 years) with a mean disease duration of 9.2±14.1 months were included. BCVA improved significantly from 0.55±0.54 logMAR (20/70) at baseline to 0.29±0.39 logMAR (20/40) at 12 months (p<0.001) with a mean of 4.9±2.9 anti-VEGF injections. CMT, SFCT and retinal thickness at site of CNVM reduced significantly (p<0.001, <0.001 and 0.02, respectively) through 12 months. The most common disease aetiologies were neovascular age-related macular degeneration, and idiopathic, inflammatory and angioid streaks. Age (p=0.04) and baseline BCVA (p<0.001) were significant predictors of change in BCVA at 12 months.

Conclusion Peripapillary CNVM, though uncommon, is associated with diverse aetiologies. Anti-VEGF agents lead to significant visual acuity and anatomical improvement in these eyes over long term irrespective of the aetiology.

  • peripapillary choroidal neovascularisation (CNV)
  • age-related macular degeneration (AMD)
  • inflammatory cnv
  • angioid streaks
  • optic nerve head drusen
  • idiopathic intracranial hypertension (IIH)
  • anti-vascular endothelial growth factors (VEGF)
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Footnotes

  • Contributors ATF, ML, AMM, CF, JFA and JC were involved in the design of the study. ATF, SFB, ML, SM, DZ, MI, RGP, AMM and JC were involved in the collection of data. SRS, ATF, ML, MI, AMM and LW were responsible for interpretation and analysis of data. SRS, ATF, SFB, ML, PHG, DZ, PMLC, LHL, RS, SHU and JC were involved in manuscript writing. SRS, ATF, SFB, ML, SM, PHG, DZ, MI, PML, RGP, CF, LHL, AMM, AMBC, LW, RS, SHU, VG, JFA and JC reviewed the article. All authors conducted the study and equally contributed in the preparation, review and approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the local ethics committee and the institutional review board at the respective sites.

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

  • Data availability statement Data are available upon request.

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