Intravitreale Anti-VEGF-Behandlung choroidaler Neovaskularisationen (CNV) bei pathologischer Myopie (PM): ein Review

 

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Zusammenfassung

Die Anti-VEGF-Injektionstherapie der choroidalen Neovaskularisationen bei pathologischer Myopie wird derzeit als „off-label use“ angewendet, basierend auf den Ergebnissen zahlreicher kleinerer Studien mit geringen Fallzahlen. In diesem Review wurden Ergebnisse von Fallserien mit jeweils mindestens 20 behandelten Augen und einer Nachbeobachtungszeit von mindestens 12 Monaten zusammenfassend analysiert. In der Medline-Recherche konnten 18 Fallserien identifiziert werden, die diesen Anforderungen entsprechen. Im Mittel aller Studien wurde nach 12 Monaten ein Visusgewinn von 2,2 ± 0,7 (Mittelwert ± 1 Standardabweichung, Fallzahl-gewichtet: 2,0) Zeilen mit durchschnittlich 3,0 ± 1,7 Injektionen (Fallzahl-gewichtet: 2,7) erzielt. Ein signifikanter Unterschied der Visusergebnisse zwischen Bevacizumab und Ranibizumab konnte nicht festgestellt werden. Der mittlere Visusgewinn des 1. Jahres konnte im 2. Beobachtungsjahr mit einem Endvisus von durchschnittlich 2,2 ± 1,0 Zeilen stabilisiert werden. Das durchschnittliche Alter der Patienten bei Behandlungsbeginn lag bei 56,0 ± 6,0 Jahren (Fallzahl-gewichtet: 56,2 Jahre). Die Ergebnisse dieser Übersichtsanalyse zeigten, dass mit einem relativ geringen Aufwand an Injektionen auf langer Zeitskala eine günstige funktionelle Entwicklung der choroidalen Neovaskularisation bei pathologischer Myopie erreicht werden kann.

Abstract

Anti-VEGF injections are widely used “off-label” for the treatment of choroidal neovascularization secondary to pathological myopia based on data generated by multiple case series with small sample sizes. In this review we have analyzed the results of case series with at least 20 patients and a follow-up of ≥ 12 months. 18 case series were identified in Medline meeting these demands. The mean gain of visual acuity after 12 months was 2.2 ± 0.7 (mean ± 1 standard deviation, case number weighted: 2.0) lines with a mean of 3.0 ± 1.7 injections (case number weighted 2.7). There was no significant difference between bevacizumab and ranibizumab. The mean gain of visual acuity in the first year could be stabilized in the second year with a visual acuity of a mean of 2.2 ± 1.0 lines at the end of follow-up. The mean age of patients at the beginning was 56.0 ± 6.0 (case number weighted: 56.2). The results of this analysis indicate very clearly that a favourable long-term outcome can be achieved with a relatively small number of injections in cases of choroidal neovascularization secondary to pathological myopia.

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