Intravitreal anti-VEGF treatment for choroidal neovascularization secondary to traumatic choroidal rupture

Abstract

BackgroundSo far only single cases with short follow-up have been reported on the use of intravitreal anti-VEGF for traumatic choroidal neovascularizations (CNV). This paper reports a large case series of patients with CNV secondary to choroidal rupture after ocular trauma receiving intravitreal anti-VEGF (vascular endothelial growth factor) injections.MethodsFifty-four patients with unilateral choroidal rupture after ocular trauma diagnosed between 2000 and 2016 were retrospectively evaluated. Eleven patients with CNV secondary to choroidal rupture were identified. Five eyes with traumatic secondary CNV were treated with anti-VEGF and were systematically analysed. The other 4 patients with inactive CNV underwent watchful observation.ResultsFour men and one woman with a mean age of 29 years (SD 12.4; range 19–45) had intravitreal anti-VEGF therapy for traumatic CNV. Another 4 patients with a mean age of 37 years (SD 6.6; range 31–46) presented with inactive CNV and did not receive specific treatment. In all 9 cases the mean interval between the ocular trauma and the diagnosis of CNV was 5.7 months (SD 4.75; range 2–12). In the treatment group per eye 4.2 injections (SD 3.2; range 1–8) were given on average. Four eyes were treated with bevacizumab and one eye with ranibizumab. Regression of CNV was noted in all eyes. In 4 eyes visual acuity (VA) improved, one eye kept stable visual acuity.ConclusionsHere, we present the up to now largest case series of traumatic CNV membranes treated with anti-VEGF injections with a mean follow-up period of 5 years. Intravitreal anti-VEGF therapy seems to be safe and effective for secondary CNV after choroidal rupture. Compared to exudative age-related macular degeneration fewer injections are needed to control the disease.Trial registrationRetrospective registration with local ethics committee on 21 March 2019. Trial registration number is 19-1368-104.

Optical coherence tomography angiography-guided diagnosis of a traumatic choroidal rupture-associated choroidal neovasular membrane and its management with intravitreal ranibizumab

“…had reported relatively higher incidence of CNVM (20%) out of 54 diagnosed patients with posttraumatic CR. [ 3 ] Thus, although CR itself requires no active intervention, it must be closely monitored for the potential of CNVM formation. In our patient, large crescent-shaped CR was noted; temporal extent of the rupture was close to fovea.…”

“…have treated five patients of CR associated active CNVM by either bevacizumab or ranibizumab with an average of 4.2 injections per eye for regression over a mean follow-up period of 5 years. [ 3 ] However, in 40% of eyes single injection of anti-VEGF was sufficient to induce quiescence, and only one eye showed recurrence 6 months post treatment. The remaining three eyes (60%) were treated with upload of three monthly injections initially.…”

“…The remaining three eyes (60%) were treated with upload of three monthly injections initially. [ 3 ] This might explain the higher mean number of injections reported for achieving quiescence by Barth et al . [ 3 ] as compared to other reports.…”

“…[ 3 ] This might explain the higher mean number of injections reported for achieving quiescence by Barth et al . [ 3 ] as compared to other reports. [ 10 ] In our case, the patient responded to a single intravitreal anti-VEGF agent and her visual acuity at 6-month follow-up improved to 20/30.…”

“…Intravitreal anti-vascular endothelial growth factor (VEGF) is considered as the mainstay of the management of CR-associated CNVM. [ 3 ] Currently, optical coherence tomography angiography (OCTA) has emerged as a noninvasive imaging modality for the early detection of CNVM of variable etiology with good specificity. [ 4 ] In the index case, we report OCTA-guided early diagnosis of a traumatic CR-associated CNVM in a young female following sports injury and demonstrate its successful regression with single intravitreal ranibizumab injection.…”