COMPARATIVE LONG TERM RESULTS OF THREE DIFFERENT THERAPIES FOR MYOPIC CHOROIDAL NEOVASCULARIZATION J.A. Montero, J.M. Ruiz-Moreno VISSUM, Alicante Institute of Ophthalmology, Vitreo-Retina Unit, Alicante Pio del Rio Hortega University Hospital, Ophthalmology Unit, Valladolid Department of Ophthalmology, Castilla La Mancha University, Albacete SPAIN

Introduction Myopic maculopathy is the main cause of vision loss among highly myopic patients, and the leading aetiology of subfoveal choroidal neovascularization (CNV) among patients younger than 50 years of age.Myopic maculopathy is the main cause of vision loss among highly myopic patients, and the leading aetiology of subfoveal choroidal neovascularization (CNV) among patients younger than 50 years of age. Different therapeutic approaches have been attempted such as thermal laser photocoagulation, radiotherapy, surgery and photodynamic therapy with verteporfin (PDT). Presently the new antiangiogenic drugs have been used off-label to treat subfoveal CNV secondary to high myopia.Different therapeutic approaches have been attempted such as thermal laser photocoagulation, radiotherapy, surgery and photodynamic therapy with verteporfin (PDT). Presently the new antiangiogenic drugs have been used off-label to treat subfoveal CNV secondary to high myopia.

Aim To compare the eficacy of argon laser, PDT and intravitreal bevacizumab in myopic CNV at two years.

Methods Interventional, retrospective, non randomized. Seventy-six patients (82 eyes) were treated by argon laser, PDT or intravitreal bevacizumab and followed during two years. Verteporfin PDT was performed as described for the VIP study. Patients received further PDT sessions in those cases when fluorescein leakage was identified. PDT was performed not earlier than 3 months after the last session, following fluorescein angiography (FA). Intravitreal bevacizumab (1.25 mg) was injected during three consecutive months and repeated when decreased visual acuity and re activation of CNV was observed by FA or Optical Coherence Tomography (OCT).

Results Two recurrences appeared in the laser treated group (23 eyes).Two recurrences appeared in the laser treated group (23 eyes). Argon laser photocoagulation, photodynamic therapy and intravitreal bevacizumab achieved CNV closure.Argon laser photocoagulation, photodynamic therapy and intravitreal bevacizumab achieved CNV closure. Best corrected visual acuity gain was statistically significant in the three groups during the first year though the improvement became non significant by the end of the second to third year of follow up.Best corrected visual acuity gain was statistically significant in the three groups during the first year though the improvement became non significant by the end of the second to third year of follow up.

Results The average number of PDT sessions needed to achieve CNV closure was 3.3 (range 1 to 6; 2.3 during the first year fo follow-up) in the PDT group during the four year period (39 eyes).

The average number of intravitreal bevacizumab injections was 1.4 (four recurrences during the first year and four recurrences during the second year)(19 eyes).The average number of intravitreal bevacizumab injections was 1.4 (four recurrences during the first year and four recurrences during the second year)(19 eyes). Results

Results BevacizumabPDT Argon laser

Conclusion Direct argon green laser photocoagulation in high-myopic juxtafoveal CNV, and PDT and bevacizumab in subfoveal CNV may improve BCVA initially between two and 24 months. Direct argon green laser photocoagulation in high-myopic juxtafoveal CNV, and PDT and bevacizumab in subfoveal CNV may improve BCVA initially between two and 24 months. The improvement fades with time, and is no longer significant after the third year. The improvement fades with time, and is no longer significant after the third year.