Clinical Evaluation Of Intravitreal Lucentis Injection Therapy For Choroidal Neovascularization Due To Pathologic Myopia

objective:Pathologic myopia(PM)is a common clinical retinal diseases. Pathologic myopia choroidal neovascularization(m CNV), it always lead to serious vision loss of young people. There is no specific clinical treatment.In this study, patients with m CNV were treated with intravitreal anti-Vascular endothelial growth factor(VEGF) agents- Ranibizumab(trade name Lucentis),by observing and comparing outcomes of the best corrected visual acuity(BCVA), central retinal macular thickness(CRT) and fundus fluorescein angiography(FFA) of different groups, to assess the effect of intravitreal Lucentis on m CNV and find the best clinical treatment of the disease.methods:Analysis and collect patients with m CNV in the Hospital of Jilin University from January 2014 to December 2015.Diagnosis is based on patient typical fundus changes, optical coherence tomography(OCT) and FFA results. Then selected 60 patients(62 eyes) according to the inclusion criteria and exclusion criteria.The cases were divided into two groups: experiental group of 29 patients(30 eyes) received intravitreal Lucentis0.05ml(0.5mg)injection combine taking Fufang Xueshuantong capsule;another group of 31 patients(32 eyes) just take Fufang Xueshuantong capsule. The method of taking capsule 3 times a day, take three capsule once for 3 consecutive months. Two groups were created from experiental group accordding to different initial dosing regimens:group A and group B.Group A included 15 patients(15 eyes) treated by a single intravitreal injection.Group B included 14 patients(15 eyes) treated by three consecutive monthly injections. Additional injections were performed if needed.All patients were followed up for 6 months. Each patient was reviewed once a month and the(BCVA), intraocular pressure, retinal, anterior segment, foveal thickness and fundus fluorescein angiography change were recorded and evaluated.statistical methods:We used SPSS statistical software, version 19.0 for statistical analysis. BCVA results were converted to a logarithm of the minimum angle of resolution(log MAR) value. Continuous data are presented as means±standard deviation.(X ± SD); Independent t-test was used to compare continuous variables between groups and used the paired t-test to compare changes in BCVA,CRT before and after treatments. Ratio variables between groups were compared using chi square test. We regarded a = 0.05 level and a p-value of < 0.05 to be statistically significant.results:1.BVCA: After treatment, the experimental group,Mean BCVA improved from 0.937 士 0.135 log MAR at baseline to 0.58 士 0.124 log MAR at the final follow-up.The control group, Mean BCVA improved from 1.003 士 0.159 log MAR at baseline to 0.733 士 0.116 log MAR at the final follow-up.And the improvement from baseline remained statistically significant(P <0.005).Also, the differences in mean BCVA at final follow-up visit were statistically significant in both groups(P <0.005);2.CRT: Mean CRT decreased from 325.93士12.92 um to 260.43士10.55 um in experimental group and from 321.60士16.27 um to 285.80士15.22 um in contral group at final follow-up visit.These differences were statistically significant(P <0.005). Also, the differences in mean CRT at final follow-up visit were statistically significant in both groups(P <0.005);The differences in mean decreased CRT of the two group were respectively 65.50 um and 35.77 um and that was statistically significant in both groups(P <0.005); The decrease of mean CRT in experimental group were lower than the control group;3.FFA: After treatment, 28 eyes(93%) in the experimental group leakage stoped or decrease; 22 eyes(69%) in the control group leakage stoped or decrease. Difference between the two groups was statistically significant(P <0.05). The ratio of leakage stoped or decrease in experimental group is greater than in the control group.4. Experimental group divided into two group A(1 + PRN) and group B(3 + PRN), the average times of treatments of Group A(1 + PRN) is 1.80, the average times of treatments of group B(3 + PRN) is 3.20. Difference between the two groups was statistically significant(P <0.05).5.BCVA was 0.573士0.12 log MAR at the final follow-up in group A and 0.578士0.14 in group B.The mean CRT was 260.53士10.70 um in group A and 260.33士10.78 um in group B.There was no significant difference between two groups in mean BCVA、CRT at final follow-up visit. t value were-0.289,0.051, P value were 0.775,0.96.conclusion:1. IVR was safe and effective treatment for m CNV. IVR can effectively improve and stabilize visual acuity, reduced retinal edema caused by m CNV. IVR can suppress and reduce leakage of m CNV.2. IVRwith 1 + PRN regimen has good outcome, but also decrease number of treatments, reduce treatment costs while reducing the risk of repeatedly injection.3. VEGF factor may play a role in the development of m CNV.