Comparison Of Efficacy And Safety Of Aflibercept Versus Conbercept For Treatment Of Pathological Myopic Secondary Choroidal Neovascularization

Objective:The aim of the study was to evaluate and compare the efficacy and safety of intravitreal injection of Aflibercept and Conbercept in treatment of PM secondary CNV.Methods:The study adopts a retrospective case-control study.From December 2019 to January 2022,43 patients(43 eyes)diagnosed as pathological myopia pathological myopia(PM)secondary choroidal neovascularization(CNV)by fundus fluorescence angiography(FFA)and optical-related tomography(OCT)were analyzed in the Second Affiliated Hospital of Nanchang University.Depending on the treatment,it is divided into the Aflibercept group(group A)and the Conbercept group(group C).Group A 18 patients performed 18 ophthalmic 3 + PRN Aflibercept intraocular injection treatment,and group C 25 patients performed 25 ophthalmic 3 + PRN Conbercept intraocular injection therapy.Monthly follow-up after the first treatment,follow-up every 2 to 3 months after 1 year,a total of 18 to 26 months,an average of21.9 ± 2.5 months.None of the patients had previously received any other treatment.Then the 1st,3rd,6th,12 th,and final follow-up time after treatment was selected as the main observation time point.The BCVA and CMT at pre-and post-treatment follow-up were measured at the 1st,3rd,6th,12 th,and final follow-up.The two groups were compared for changes in BCVA and CMT,leakage of CNV lesions,and number of injections.Results:1、BVCAThe BCVA at the observation time point after treatment in both treatment groups was significantly better than before treatment,and the difference was statistically significant(P<0.05).There were no significant and no statistically significant differences in the comparison of BCVA months,March,June,December,and last follow-up visits after treatment between the two groups(P=0.409,P=0.619,P=0.792,P=0.835,P=0.783).At the last follow-up,more patients in group A had BCVA gaining more than 0.6log MAR units than group C.During the whole follow-up process,the visual gain between the two groups was compared,and the difference was not statistically significant(P=0.537,P=0.206,P=0.934,0.932,P=0.764).Both BCVA groups achieved maximum visual gain at month 3 follow-up,and there was no statistically significant difference in visual gain between the two groups(P<0.05).2、CMTThe mean CMT of each observation time point after treatment in the two treatment groups was significantly better than before treatment,and the difference was statistically significant(P<0.05).The average CMT of each observation time point after treatment between the two groups was not statistically significant(P=0.492,P=0.444,P=0.549,P=0.683,P=0.199).During the whole follow-up process,the mean CMT decrease in group A was greater than that in group C,but there was no significant difference between the two groups and no statistical significance(P=0.157,P=0.121,P=0.231,P=0.936,P=0.143).During the follow-up period,the best CMT in both groups appeared in the3 rd month after treatment,and there was no significant difference between the two groups(P<0.05).3、FFA shows CNV leakageThe two treatment groups used FFA to check the improvement of fluorescence leakage of CNV lesions before and after treatment,and the observation time points between the two groups were compared,and the difference was not statistically significant(P=0.417,P=0.362,P=0.787,P=0.491).During the whole follow-up process,more patients with leakage exacerbations in the 12 th month were observed,with 3 cases in group A and 5 cases in group C,with the lowest overall improvement rates of 83.3% and 80%,respectively,16 patients in group A undergoing recurrent or multiple intravitreal injection therapy,and 22 patients in group C undergoing re-or-multiple intravitreal injection therapy.4、Number of injectionsThe average number of treatments in groups A and C was 5.44± 1.20,4.72±1.10,respectively,and the difference was statistically significant,with P<0.05(P=0.047).5、The adverse eventsDuring the treatment process,several cases of high intraocular pressure and subconjunctival hemorrhage occurred in the treatment group,and no serious adverse events such as infectious endophthalmitis,retinal detachment,retinal pigment epithelium tear,and systemic thromboembolism did not occur.Conclusion:1.There was no significant difference in the efficacy of Aflibercept and Conbercept,two fusion protein anti-VEGF drugs,on PM secondary CNV,which can improve vision and macular structure;2.The treatment of PM CNV by two fusion protein anti-VEGF drugs cannot maintain the efficacy for a long time,and most of them need to be injected repeatedly.Overall,the average number of injections in Conbercept is less frequent,which reduces the financial burden on patients.