Diagnosis And Treatment Of Choroidal Neovascularization Secondary To Pathological Myopia

Part 1 The efficacy of Conbercept for treatment of choroidal neovascularization secondary to pathologic myopia and correlation of visual prognosisObjective To observe and evaluate the efficacy and safety of conbercept in the treatment of pathological myopia(PM)choroidal neovascularization(CNV),and to explore the factors affecting visual prognosis and the number of intravitreal injections.Methods A retrospective case study.Forty-seven eyes of 47 patients with pathological myopia diagnosed by clinical examination were included in the study.Among them,there were 12 eyes in 13 eyes and 36 eyes in 36 women.The average age(56.67±13.90)years,mean diopter(-13.64±3.92)D,average axial length(29.03±1.36)mm.All patients were treated for the first time.All patients were treated with 1+PRN for intravitreal injection of conbercept 0.05ml(containing conbercept 0.5mg).Best corrected visual acuity(BCVA),fundus color photography,fluorescein fundus angiography(FFA),and optical coherence tomography(OCT).The BCVA examination uses an international standard visual acuity chart and is converted to the minimum resolution logarithm(logMAR)visual acuity.Followed up more than 24 months.Observe the BCVA,central macular thickness(CMT),CNV area,CNV leakage area and the number of vitreous cavity injections at 1,3,6,12,24 months after treatment;logMAR BCVA will be treated 24 months after treatment The total number of injections and the baseline data(diopter,eye axis,PM stage,CNV location,logMAR BCVA,CMT,CNV area,area of CNV leakage)were analyzed by Person and Spearman.Results During the 24-month follow-up period,the average number of needles in the first year was 3.51±1.54,the average number of needles in the second year was 0.57±1.02,and the total number of needles was 4.081±1.75.Compared with before treatment,BCVA was significantly increased in the eyes at 1,3,6,12,and 24 months after treatment,and the difference was statistically significant(t=7.11,7.51,7.88,7.42,7.40;P=0.000,0.000,0.000,0.000,0.000).Compared with before treatment,the CMT of the eyes decreased significantly at 1,3,6,12,and 24 months after treatment,and the difference was statistically significant(t=6.20,4.58,3.53,3.12,3.81;P=0.000,0.000,0.001,0.003,0.000).Compared with before treatment,the CNV area of the affected eyes decreased significantly at 3,6,12,and 24 months after treatment,and the difference was statistically significant(t=4.97,6.12,3.66,4.32;P=0.000,0.000,0.000 0.000).Compared with before treatment,the area of CNV leakage decreased significantly at 3,6,12,and 24 months after treatment,and the difference was statistically significant(t=6.55,7.83,7.44,7.56;P=0.000,0.000,0.000,0.000).Correlation analysis showed that there was no significant correlation between logMAR BCVA at 24 months after treatment and diopter,axial length,PM stage,CNV location,CMT,CNV area at baseline(P>0.05);positive correlation with logMARR BCVA at 24 months after treatmen and area of CNV leakage at baseline(r=0.595,0.319;P=0.000,0.026).There was no significant correlation between the total number of needles and diopter,axial length,PM stage,CNV location and CNV area at baseline(P>0.05);positive correlation with baseline CMT,CNV area and area of CNV leakage(r=0.297,0.440,0.433;P=0.038,0.002,0.002).All patients had no ocular complications and systemic adverse reactions.Conclusion Conbercept treatment of pathological myopia with CNV can bring better vision benefit and anatomical benefit,and it is safe and effective.The last follow-up BCVA has correlation with baseline BCVA and area of CNV leakage,and the total number of injections correlation with baseline CMT,CNV area,and area of CNV leakage.Part 2 Efficacy of different initial dosing regimens of intravitreal conbercept in pathological myopic choroidal neovascularizationObjective To compare the efficacy and recurrence rate of different initial dosing regimens of conbercept in the treatment of pathological myopic(PM)choroidal neovascularization(CNV).Methods A retrospective case-control study.From June 2013 to June 2017,61 eyes of 57 patients of PM-CNV diagnosed in our hospital were included in the study.According to the patient’s initial treatment plan,the 1+PRN treatment group(group A)and the 3+PRN treatment group(group B)were 31 eyes of 27 patients eyes and 30 eyes of 30 patients,respectively.All patients underwent intravitreal injection of cobercept.On-demand treatment was based on repeated treatment criteria after the initial treatment.The average follow-up time was 30.8 months.All performed best corrected visual acuity(BCVA),intraocular pressure,slit lamp microscope,fundus color photography,fluorescein fundus angiography,and optical coherence tomography.The BCVA examination uses an international standard visual acuity chart and is converted to the minimum resolution logarithm(LogMAR)visual acuity.The time point was determined as the therapeutic efect 24 months after treatment.The frequency and recurrence rate of vitreous cavity injection and BCVA,CMT,diopter and axial changes were compared between the two groups.Results There were no significant differences between the two groups in the baseline statistics.At 24 months after treatment,the frequency of intravitreal injections in group A and group B were(3.94±1.88)and(4.83±1.72),respectively,and the difference was statistically significant(P=0.029).After treatment,the number of retreatment needles was(2.94±1.88)(1.83±1.72),and the difference was statistically significant(P=0.020).The recurrence rate of CNV was statistically different between 38.71%and 13.33%,respectively(2=5.074,P=0.024).There was a statistically significant difference in mean BCVA at 1,3,6,12,and 24 months after treatment in group A(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000).Compared with before treatment,the mean CMT decreased at 1,3,6,12,and 24 months after treatment(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000);There was a statistically significant difference in mean BCVA at 1,3,6,12,and 24 months after treatment in group B(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000).There was a statistically significant difference in mean CMT reduction at 1,3,6,12,and 24 months after treatment(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000).After treatment,the mean BCVA of two groups was not statistically different at 1,3,6,and 12 months(P=0.334,P=0.351,P=0.601,P=0.079).The logMAR BCVA of the two groups at 24 months were(0.58±0.39),(0.34±0.21),and there was statistical difference at 24 months(P=0.012).There was no significant difference in mean CMT between the two groups at 1,3,6,12,and 24 months after treatment(P=0.457,P=0.871,P=0.505,P=0.333,P=0.798).All patients had no ocular complications and systemic adverse reactions.Conclusion Different initial dosing regimens of conbercept are safe and effective for the treatment of PM-CNV.There is no significant difference that both groups can effectively improve BCVA and reduce CMT.Total injection of 3+PRN is more than 1+PRN.However,the injections of retreatment and CNV recurrence rate is lower,and the final follow-up vision is better.