Combined Photodynamic Therapy And Intravitreal Bevacizumab Injection For Myopic Subfoveal Choroidal Neovascularization In A37-year-old Woman After ICL Implantation

Pathologic myopia (PM), or high myopia, degenerative myopia, is defined as a spherical equivalent refractive error of at least-6.0dioptres(D), an axial length>26mm, accompanied with degenerative changes of the retina, choroid and sclera at the posterior segment. The fundus abnormalities include lacquer cracks, Fuch’s spot, chorioretinal atrophy, choroidal neovascularization (CNV) and so forth. CNV is an important cause of significant visual impairment in patients with PM.Different therapeutic interventions have been utilized to treat myopic CNV, including laser photocoagulation, transpupillary thermotherapy (TTT), photodynamic therapy (PDT), surgery and several pharmacologic agents.It is not suitable to perform Keratorefractive surgeries such as photorefractive keratectomy (PRK) or laser-assisted in-situ keratomileusis (LASIK) for pathologic myopia because of high degrees of refraction. Intraocular refractive surgery includes phakic intraocular lenses (IOLs) implanted in the anterior or posterior chamber, which provide good refractive results for higher corrections. The Implantable Contact Lens (ICL) is a posterior chamber lens developed by Staar Surgical (A.G. Nidau) to correct high myopia. Its safety, efficacy, and predictability of its implantation in eyes has been demonstrated in many publications. Though the refractive condition of patients after ICL implantation has been changed, the pathophysiologic property of pathologic myopia has not been changed. From now on, no evidence shows there is relationship between ICL implantation and CNV formation in pathologic myopia. Thus far, treatment modalities for mCNV in eyes after implantable contact lens (ICL) implantation have not been discussed.The medical chart of one37-year-old Chinese woman after ICL implantation from the department of Ophthalmology, the First Affiliated Hospital, College of Medicine, Zhejiang University, who treated with PDT, combined PDT with intravitreal bevacizumab injection was reviewed. In our patient’s more than4years follow-up period, after treatments of PDT and PDT combined with intravitreal bevacizumab injection, her condition is now basically controlled. The CNV membrane became an inactive scar after the second time of treatment, the BCVA was stabilized in20/100. FFA and ICGA shows staining of the lesion but no leakage. OCT in the left eye shows CNV is flat. No side-effect was found in this patient.The results obtained from our patient indicate that PDT, combined PDT with intravitreal bevacizumab injection may be considered as a possible option to treat myopic CNV after ICL implantation.