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Understanding the determinants of myopic choroidal neovascularization and response to treatment

Abstract

Purpose

The pathophysiologic pathways that govern the development of choroidal neovascularization (CNV) are complex. Patchy atrophy and lacquer cracks are known to be major anatomic risk factors for the development of myopic CNV, but they are not alone and much remains to be understood about other factors that influence development. In addition, a greater understanding of the modifiable and nonmodifiable factors that influence outcome, resolution, and recurrence after intravitreal injection of anti-vascular endothelial growth factor (VEGF) could lead to more personalized treatment algorithms that integrate parameters other than the presence of CNV itself and could help improve clinical outcomes and reduce recurrence.

Methods

We reviewed recently published data on risk factors for CNV and predictors of response to anti-VEGF treatments. In particular, data pertaining to age, sex, genetic predisposition, baseline visual acuity, axial length, staphyloma, lacquer cracks, atrophic lesions, choroidal thickness or choroidal thinning, characteristics of CNV such as duration, localization, and size of CNV, and treatment considerations such as choice of treatment, loading doses, and combination treatments were reviewed.

Results

Our analysis showed that the body of evidence is incomplete.

Conclusions

Additional studies are required to identify high-risk patients and to develop personalized therapeutic approaches.

Eur J Ophthalmol 2016; 26(6): 511 - 516

Article Type: REVIEW

DOI:10.5301/ejo.5000839

Authors

Nicolas Leveziel, David Gaucher, Stéphanie Baillif, Xavier Benouaich, Claire Chartier, Thyphaine Grenet, Vincent Gualino, Valérie Krivosic, Marie Noelle Delyfer

Article History

Disclosures

Financial support: Supported by Novartis Pharma.
Conflict of interest: N. Leveziel: advisory board for Novartis, Allergan and Bayer. D. Gaucher: advisory board for Novartis, Allergan, and Bayer, who have funded congresses. S. Baillif: advisory board for Novartis and Bayer. X. Benouaich: Advisory board for Novartis. C. Chartier has been an employee of Novartis. T. Grenet: advisory board for Novartis and Bayer. V. Gualino: consultancy for Alcon, Allergan, Bayer, and Novartis. V. Krivosic: advisory board for Novartis and Bayer. M.N. Delyfer: advisory board for Novartis.

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Authors

Affiliations

  •  Department of ophthalmology, CHU Poitiers, Poitiers - France
  •  New Civil Hospital, University Hospitals of Strasbourg, Strasbourg - France
  •  Laboratory of Bacteriology (EA-7290), Federation of Medicine Translational of Strasbourg, University of Strasbourg, Strasbourg - France
  •  Ophtalmology Department, University Hospital of Saint Roch, University of Nice Sophia Antipolis, Nice - France
  •  Clinic of Union, Union - France
  •  Novartis, Rueil-Malmaison - France
  •  Ophthalmic Imaging and Laser Center, Paris - France
  •  Honoré Cave Clinic, Montauban - France
  •  Department of Ophthalmology, University Hospital of Lariboisière, Paris Hospitals, Paris - France
  •  University Hospital of Toulouse, Purpan, Paule de Viguier, Toulouse - France
  •  Private Clinic and University Hospital of Lariboisière, Paris Hospitals, Paris - France
  •  Department of Ophtalmology, University Hospital of Bordeaux, Bordeaux - France
  •  Department of Ophthalmology, Pellegrin Hospital, Bordeaux - France
  •  University of Bordeaux, France-INSERM, ISPED, INSERM Center U897-Epidemiology Biostatistics, Bordeaux - France

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