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Publication Detail
Intravitreal anti-vascular endothelial growth factor treatment for inflammatory choroidal neovascularization in non-infectious uveitis.
PURPOSE: To compare visual outcome and recurrence rates of eyes with non-infectious inflammatory CNV treated with or without anti-VEGF injections and immunosuppression. DESIGN: Retrospective, non-randomized clinical study METHODS: : Participants: Patients with CNV secondary to non-infectious inflammatory causes who attended uveitis clinics at Moorfields Eye Hospital between January 2000 and April 2016. Data was gathered from the clinical notes of all subjects examined in clinic. MAIN OUTCOME MEASURES: change in best corrected visual acuity (BCVA), mean time to CNV recurrence, moderate vision loss (MVL; ≤ 20/50), severe vision loss (SVL; ≤20/200). RESULTS: A total of 166 patients (204 eyes) with non-infectious inflammatory CNV were included in this study with a median follow-up of 6.9 years (IQR: 2.9-11.7; 1652 eye-years). The mean BCVA at the time of CNV diagnosis was 0.38±0.05 logMAR (Snellen equivalent 20/47) in the eyes which received the first-line anti-VEGF treatment and 0.44±0.03 logMAR (Snellen equivalent 20/55) in the eyes on other treatment modalities (p=0.39). Eyes treated first with anti-VEGF (n=55) received the mean of 4.35±0.53 injections and showed a statistically significant improvement in vision at all time points (p<0.001) except for a 5-year visit (p=0.25). The rest of the eyes demonstrated no significant change in vision throughout follow-up (all p>0.05). At the final visit the mean BCVA was 0.26±0.11 logMAR (Snelllen equivalent 20/36) in the former and 0.35±0.06 logMAR (Snellen equivalent 20/44) in the latter. The mean time to CNV recurrence was 186±15.1 months and the risk was significantly reduced by treatment with oral corticosteroids (aHR=0.32, CI:0.17-0.59, p<0.001) or anti-VEGF injections (aHR=0.31, CI:0.18-0.52, p<0.001). CONCLUSIONS: Eyes that developed inflammatory CNV were at risk of vision loss. Those receiving early anti-VEGF injections achieved a better visual outcome and had a reduced risk of CNV recurrence. Oral corticosteroids also had an effect reducing the risk of recurrence in eyes previously treated.
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