Long-term clinical effects of intravitreal injections of conbercept for the treatment of choroidal neovascularization in patients with pathological myopia

Abstract

AIM: To observe the long-term clinical efficacy of intravitreal injections of conbercept, a novel vascular growth factor inhibitor, for the treatment of pathological myopia choroidal neovascularization (PM-CNV). METHODS: A total of 67 eyes (from 67 patients; mean age, 54.90±12.7y) with PM-CNV were retrospectively researched. Based on the different schemes used for the administration of the drug, the patients were divided into two groups: group A (n=35; average age, 53.31±13.6y; average diopter, 9.25±1.72 D), which received only one injection of pro re nata (PRN; 1+PRN regimen), and group B (n=32; average age, 56.49±11.8y; average diopter, 9.63±2.24 D), which received one injection per month for 3mo (3+PRN regimen). Best-corrected visual acuity (BCVA) analysis, intraocular pressure (IOP) examination, slit-lamp microscopy, fundus examination and optical coherence tomography were performed at each follow-up. The recurrence and treatment times of CNV were recorded. The patients were followed up for at least 12mo. RESULTS: The BCVA was increased in 29 eyes (82.9%) in group A and 30 eyes (93.75%) in group B; no increase or decrease was observed in 6 (17.1%) and 2 (6.25%) eyes in groups A and B, respectively. The BCVA (logMAR) values before treatment (0.67±0.48 and 0.71±0.56) were significantly higher than those 12mo after treatment (0.31±0.26 and 0.33±0.17) in groups A and B, respectively (P<0.05). The mean central macular thickness (CMT) values had significantly decreased from 346.49±65.99 and 360.10±82.31 μm at baseline to 257.29±40.47 and 251.97±48.26 μm in groups A and B, respectively, after 12mo of treatment. A total of 21 eyes in group A needed reinjection (60%; average number of injections, 2.51±0.98); the corresponding values in group B were 6 eyes (18.75%; average number of injections, 3.74±1.22). There were no adverse ocular and systemic complications during the treatment and follow-up. CONCLUSION: Intravitreal injection of conbercept with 1+PRN or 3+PRN improve the visual acuity, reduce macular edema and reduce the level of CMT in patients with PM-CNV. The 3+PRN regimen demonstrates a lower recurrence rate of CNV than the 1+PRN regimen, but requires more treatment. However, both treatment regimens demonstrate long-term safety and efficacy for the treatment of PM-CNV.

Safety of Receiving Anti–Vascular Endothelial Growth Factor Intravitreal Injection in Office-Based vs Operating Room Settings

“…No patient developed RD according to 2 studies in the office setting and 1 study in the OR, whereas another study reported an RD rate of 0.003% in the OR. Two studies in the office setting gave a combined incidence rate of 0.01% and 0.02% for vitreous hemorrhage and RT, respectively.…”

“…The baseline characteristics of the included studies are detailed in eTable 1 in the Supplement. Seventeen studies reported a total of 944 765 injections administered in the office setting, while 14 studies reported 302 039 injections administered in the OR . Only 2 studies directly compared office-based injections with the OR-based injections: Abell et al reported no significant difference in age, sex, ocular comorbidities, or socioeconomic status between the 2 injection settings, while Tabandeh et al indicated similar baseline diagnosis; patients in both studies were injected with ranibizumab or bevacizumab.…”

“…For comparative analysis (Figure 2A), there was no difference between the 2 injection settings (odds ratio, 3.06; 95% CI, 0.07-139.75; P = .57), but significant heterogeneity was observed ( I 2 = 80%). The pooled rates of EO in the office and OR settings are presented in Figure 3 . In the office setting, the rates of EO following IVI of total anti-VEGF drugs, ranibizumab, bevacizumab, and aflibercept were 0.03% (95% CI, 0.03-0.04), 0.03% (95% CI, 0.03-0.04), 0.04% (95% CI, 0.03-0.05), and 0.04% (95% CI, 0.02-0.05), respectively.…”

“…The culture-positive EO rate was significantly higher in the office setting compared with the OR setting, with no statistical heterogeneity being observed (odds ratio, 21.52; 95% CI, 2.39-193.55; P = .006; I 2 = 0%) (Figure 2B). The pooled rates of culture-positive EO in the office and OR settings are presented in Figure 4 . The rates of culture-positive EO following IVI of total anti-VEGF drugs, ranibizumab, and bevacizumab were 0.01% (95% CI, 0.01-0.02), 0.01% (95% CI, 0.01-0.02), and 0.01% (95% CI, 0.01-0.02), respectively, in the office setting with no statistical heterogeneity ( I 2 = 0%; I 2 = 0%; I 2 = 0%).…”

“…IVIs with anti-VEGF agents are predominantly performed in the operating room (OR) in Europe and in resource-limited countries, such as China and India, owing to the perception of a decreased risk of infection . Given the high volume of IVIs performed annually with limited availability of ORs, these injections were typically administered in an office setting in the US .…”