Cohen Salomon Y
Centre Ophtalmologique d'Imagerie et de Laser, Paris, France.
Retina. 2009 Sep;29(8):1062-6. doi: 10.1097/IAE.0b013e3181b1bb1a.
Pathologic myopia is the second cause of choroidal neovascularization, after age-related macular degeneration (AMD), and the first cause in patients younger than 50 years. The current treatment of subfoveal myopic choroidal neovascularization (mCNV) is verteporfin photodynamic therapy, but its long-term effectiveness has been disappointing. Antivascular endothelial growth factor (anti-VEGF) drugs are now widely used not only to treat choroidal neovascularization in AMD but also for choroidal neovascularization in other conditions. This review summarizes the data supplied by published case series studies about anti-VEGF therapy in mCNV.
Analysis of the current literature allowed discussion of the optimal parameters for mCNV treatment by anti-VEGF, including the choice of anti-VEGF drug, its dose, the treatment protocol, and indications for retreatment.
To date, the results of intravitreal bevacizumab or ranibizumab for mCNV have been reported in at least 14 studies, but they were all pilot, monocentric, and noncomparative case series. Nevertheless, they provided useful information on >250 patients and showed similar results, with significant improvement of visual acuity and an excellent safety profile.
Shifting from one treatment to another is always difficult in the absence of prospective and controlled comparative studies. However, in 2009, intravitreal ranibizumab or bevacizumab may be considered as first-line therapy for sub- and juxtafoveal mCNV for three reasons: the safety of anti-VEGF drugs and intravitreal injection procedures; the disappointing long-term results of other therapies, including verteporfin treatment; and the excellent convergent results of anti-VEGF therapy in all pilot studies.
病理性近视是脉络膜新生血管形成的第二大原因，仅次于年龄相关性黄斑变性（AMD），是50岁以下患者中脉络膜新生血管形成的首要原因。目前，对于黄斑中心凹下近视性脉络膜新生血管（mCNV）的治疗方法是维替泊芬光动力疗法，但其长期疗效并不理想。抗血管内皮生长因子（anti-VEGF）药物目前不仅广泛用于治疗AMD中的脉络膜新生血管，也用于治疗其他情况下的脉络膜新生血管。本综述总结了已发表的病例系列研究提供的关于抗VEGF疗法治疗mCNV的数据。
对当前文献进行分析，以探讨抗VEGF治疗mCNV的最佳参数，包括抗VEGF药物的选择、剂量、治疗方案以及再次治疗的指征。
迄今为止，至少有14项研究报告了玻璃体内注射贝伐单抗或雷珠单抗治疗mCNV的结果，但这些研究均为初步的、单中心的且非对照的病例系列。尽管如此，这些研究为250多名患者提供了有用信息，结果相似，视力有显著改善且安全性良好。
在缺乏前瞻性对照比较研究的情况下，从一种治疗方法转向另一种治疗方法总是很困难。然而，在2009年，玻璃体内注射雷珠单抗或贝伐单抗可被视为黄斑中心凹下及近黄斑中心凹mCNV的一线治疗方法，原因有三：抗VEGF药物和玻璃体内注射操作的安全性；包括维替泊芬治疗在内的其他疗法令人失望的长期结果；以及抗VEGF疗法在所有初步研究中取得的出色趋同结果。
