Long-Term Analysis of Clinical Features and Treatment Outcomes of Inflammatory Choroidal Neovascularization

Mirinae Kim; Junhyuck Lee; Young-Gun Park; Young-Hoon Park

doi:10.1016/j.ajo.2021.07.014

Long-Term Analysis of Clinical Features and Treatment Outcomes of Inflammatory Choroidal Neovascularization

Am J Ophthalmol. 2022 Jan:233:18-29. doi: 10.1016/j.ajo.2021.07.014. Epub 2021 Jul 21.

Authors

Mirinae Kim¹, Junhyuck Lee², Young-Gun Park¹, Young-Hoon Park³

Affiliations

¹ Department of Ophthalmology and Visual Science (M.K., J.L., Y-G.P., Y.-H.P.), College of Medicine, The Catholic University of Korea, Seoul, South Korea; Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital (M.K., Y.-G.P., Y.H.P.), Seoul, South Korea.
² Department of Ophthalmology and Visual Science (M.K., J.L., Y-G.P., Y.-H.P.), College of Medicine, The Catholic University of Korea, Seoul, South Korea.
³ Department of Ophthalmology and Visual Science (M.K., J.L., Y-G.P., Y.-H.P.), College of Medicine, The Catholic University of Korea, Seoul, South Korea; Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital (M.K., Y.-G.P., Y.H.P.), Seoul, South Korea. Electronic address: parkyh@catholic.ac.kr.

PMID: 34298010
DOI: 10.1016/j.ajo.2021.07.014

Abstract

Purpose: To investigate the long-term clinical features and treatment outcomes of patients with inflammatory choroidal neovascularization (CNV) treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF).

Design: Retrospective, interventional, consecutive case series.

Methods: Sixty-five eyes of 65 patients with inflammatory CNV treated with anti-VEGF injections and followed up at least 12 months were included. Retrospective chart review was conducted at a single tertiary referral center.

Results: Study participants were followed up for 60.6 ± 42.8 (range, 16-160) months. Mean age was 33.4 ± 10.8 years, and mean refractive error was -3.94 ± 1.35 D in spherical equivalent. Final best-corrected visual acuity (BCVA) was 0.21 ± 0.20 logMAR after treatment. Patients were treated with bevacizumab (76.9%), ranibizumab (4.6%), aflibercept (3.1%), and drug combinations (15.4%). Systemic corticosteroid or immunosuppressant use was not correlated with visual outcome, required number of anti-VEGF injections, and recurrence. Commonly occurring optical coherence tomography (OCT) features included ellipsoid zone disruption, choroidal hypertransmission, retinal pigment epithelium atrophy or absence (RPEA), intraretinal hyperreflective foci (HRF), choroidal vessel engorgement, focal choroidal excavation, and irregular vascular loops (on OCT angiography). RPEA after treatment (β = 0.238, P = .036) and BCVA (β = 0.267, P = .029) showed significant correlation with final BCVA. A total of 28 patients (43.1%) experienced recurrence; intraretinal HRF after treatment was the single risk factor for recurrence (odds ratio = 2.712, P = .031).

Conclusions: Inflammatory CNV recurrence showed higher rates over time after anti-VEGF treatment than previously reported, even though the overall visual outcome was good. Baseline BCVA and RPEA after treatment are significant predictors for visual outcome. Intraretinal HRF after anti-VEGF treatment suggests the potential risk of recurrence.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Angiogenesis Inhibitors / therapeutic use
Choroidal Neovascularization* / diagnosis
Choroidal Neovascularization* / drug therapy
Humans
Intravitreal Injections
Ranibizumab / therapeutic use
Retrospective Studies
Tomography, Optical Coherence
Treatment Outcome
Vascular Endothelial Growth Factor A
Visual Acuity
Young Adult

Substances

Angiogenesis Inhibitors
Vascular Endothelial Growth Factor A
Ranibizumab