Open Access

High‑dose aflibercept injection has striking effects on myopic choroidal neovascularization

  • Authors:
    • Wei Zhu
    • Yanlei Hao
    • Zhongfang Yuan
    • Chunmei Huang
  • View Affiliations

  • Published online on: May 9, 2023     https://doi.org/10.3892/etm.2023.12000
  • Article Number: 301
  • Copyright: © Zhu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The aim of the present study was to evaluate the 1‑year outcomes of a high‑dose aflibercept injection [4 mg 2+ pro re nata (PRN) scheme] for individuals with myopic choroidal neovascularization (mCNV) through optical coherence tomography (OCT) follow‑ups. A total of 16 consecutive patients (7 males and 9 females; sixteen eyes) with mCNV were enrolled in this retrospective study. The mean age was 30.5±3.35 years and mean spherical equivalent was ‑7.31±0.90 D. Subjects received 4 mg aflibercept intravitreal injection on the day of diagnosis and 35 days later. Further injections of aflibercept were required when the following were detected by OCT and fluorescein angiography: i) Decrease in best corrected visual acuity (BCVA); ii) aggravation of metamorphopsia; iii) macular oedema; iv) macular haemorrhage; v) increase in retinal thickness; and vi) leakage. Ophthalmic examination and OCT were performed at the baseline, as well as at 1, 2, 4, 6, 8, 10 and 12 months after the initial aflibercept injection. BCVA and central retinal thickness (CRT) were evaluated at each follow‑up. The results showed that the vision of all subjects improved following the aflibercept intravitreal injection. The mean BCVA improved from 0.35±0.15 logarithm of the minimal angle of resolution (logMAR) at the baseline to 0.12±0.05 logMAR at final follow‑up (P<0.05). A reduction in metamorphopsia was observed and the mean CRT was reduced from 345.38±34.69 µm of pre‑treatment levels to 222.75±8.98 µm at the last postoperative visit (P<0.05). The mean number of injections in the present study was 2.13±0.5. Out of all patients, 13 received two injections and 3 subjects received three injections. The mean follow‑up was 13.41±1.17 months. Based on the outcomes, it was found that an intravitreal injection of high‑dose aflibercept (4 mg 2+PRN scheme) is effective for vision improvement and stabilization. In addition, it also significantly alleviated metamorphopsia and reduced the CRT in patients treated with mCNV. During the follow‑up, the eyesight of the patients was stable.

Introduction

Patients with a refractive error of <-6 degrees or an axial length of >26.5 mm and typical pathological changes in the fundus are diagnosed with pathologic myopia (PM). PM occurs in 1-3% of adults (1,2). Certain phenotypic features of PM, including patchy atrophy, the thinning of choroid and choriocapillaris, lacquer cracks and choroidal neovascularization (CNV) in the fellow eye may increase the risk of myopic CNV (mCNV) (3-5). In addition, CNV has been reported to be a vision-threatening complication in 5.2-10.2% of highly myopic eyes (6).

In recent years, the anti-vascular endothelial growth factor (VEGF) agents used in patients with mCNV have demonstrated considerable success in visual acuity gains and have led to an improvement in the patients' quality of life (7). Intravitreal and subtenon steroids, photodynamic therapy, transpupillary thermotherapy and various other treatments have had varying degrees of success in preventing visual loss in patients with CNV (8,9). Due to the good efficacy of anti-VEGF biological agents, including bevacizumab, ranibizumab and aflibercept, these have been proposed as a first-line treatment for mCNV (10). The visual prognosis and natural progression of mCNV are more favourable than those of CNV secondary to age-related macular degeneration (AMD) and patients with mCNV have shown a good response to anti-VEGF therapy (11).

Bevacizumab and ranibizumab, which are respectively a whole anti-VEGF antibody and an antibody fragment, have been mostly used in mCNV treatment targeting VEGF-A, according to studies conducted after 2006 (12,13). Aflibercept is a new recombinant fusion protein consisting of a homodimeric glycoprotein formed by the fusion of the extracellular domain of human VEGF receptor (extracellular domain 2 of VEGF receptor 1 and extracellular domains 3 and 4 of VEGF receptor 2) and the Fc portion of human immunoglobulin G1(14). It has high affinity for placental growth factors and VEGF isoforms (15). The MYRROR study indicated that aflibercept is well-tolerated and effective in the treatment of mCNV. In this trial, patients in the intravitreal aflibercept group received two injections between weeks 0 and 8(16). A recent study on the treatment of mCNV with different anti-VEGF agents pointed out that afliberceptwas more effective to resolution of CNV activation and may be preferred to maintain anatomical and visual yields in eyes with PM for longer follow-ups (17).

Studies on high-dose anti-VEGF therapy used to treat neovascular AMD have been conducted. Broadhead et al (18) found that higher dose anti-VEGF therapy may obtain improved anatomic outcomes and maintain vision, but frequent injections are required to achieve this . Another study by You et al (19) suggested that an intravitreal aflibercept injection at a high dose and frequency is an effective treatment for patients with wet AMD. Nguyen et al (20) reported that an intravitreal injection of 4 mg aflibercept is safe and well-tolerated. In the same study, the 4-mg dose significantly reduced foveal thickening, improved best corrected visual acuity (BCVA) and reduced repeat injections in patients with neovascular AMD. Current studies on the use of aflibercept for the treatment of mCNV usually use a dose of 2 mg (16,21). To date, research on the use of high-dose aflibercept for mCNV has been limited.

The number of injections varies among different studies. In the study performed by Bruè et al (22), 68.4% of patients received one or two injections and 31.6% required three to five injections over the 18-month follow-up. Another study indicated that BCVA improvement was achieved with a median of two injections and was sustained for up to 12 months (21). In the study by Korol et al (23), patients received a mean of 2.6 intravitreal injections over 12 months. Based on previous studies (18,19) and our experience, a 4 mg [2+ pro re nata (PRN) scheme] aflibercept injection was selected in the present study to observe the outcomes for patients with mCNV for 12 months of follow-up and to compare the present results with those of other studies.

Patients and methods

Patients

This retrospective study reviewed the charts of patients with mCNV encountered at the Central Hospital Affiliated to Shandong First Medical University (Jinan, China) between January 2019 and August 2021. A total of 16 consecutive subjects (7 males and 9 females; age range, 26-38 years) with mCNV were enrolled in this retrospective study. The study was approved by the ethics committee of the Central Hospital Affiliated to Shandong First Medical University (Jinan, China; approval no. 2022-130-01) and was performed according to the Declaration of Helsinki. All subjects provided written informed consent prior to treatment. CNV was diagnosed by clinical examination, optical coherence tomography (OCT; Cirrus HD-OCT 4000; Carl Zeiss Meditec, Inc.) and fluorescein angiography (FA) and/or indocyanine angiography. All patients underwent computerized optometry using a Topcon KR-800 (Beijing Dakang Instrument Co., Ltd.), axial length measurement (IOLMaster®; Carl Zeiss AG) and intraocular pressure (TOPCON CT-800). The inclusion criteria were as follows: i) High myopia with a refractive error of <-6 diopters; ii) axial length of >26.5 mm; iii) myopic retinal pathological changes (posterior staphyloma, chorioretinal atrophy, papillary crescent and lacquer cracks); iv) OCT evidence of hyperreflective lesion; v) FA detection of subfoveal active CNV; and vi) BCVA of ≥0.5 logMAR prior to treatment. The exclusion criteria were as follows: i) Patients with different macular diseases, such as ARMD and diabetic macular oedema; ii) patients with previous subfoveal or juxtafoveal laser treatment; iii) history of trauma; iv) ophthalmic surgery; v) presumed ocular histoplasmosis syndrome; vi) hereditary eye disease; and vii) any other cause of secondary CNV or spheric equivalent, such as astigmatisms.

Treatments and follow-up

All patients received an intravitreal injection of 4 mg aflibercept (Bayer AG). The lids and conjunctiva were disinfected with 10% iodophor and 5% povidone iodine, respectively. The conjunctiva was anesthetized with 1% oxybuprocaine. Aflibercept (4 mg) was injected using a 30-g needle through the pars plana (4 mm from the limbus of the phakic eye) into the vitreous and an eye patch was placed over the eye following treatment. Gatifloxacin eye drops (China Otsuka Pharmaceutical Co., Ltd.) were prescribed to be instilled four times a day for 7 days, starting on the second day after surgery. The second injection was administered 35 days later. Ophthalmic examination and OCT were performed at the baseline and at 1, 2, 4, 6, 8, 10 and 12 months after the initial injection. At each follow-up visit, a thorough ophthalmic assessment was performed, including an evaluation of BCVA and retinal morphology with OCT. FA was performed if the activity of the lesion could not be estimated by clinical expression and OCT assessment at each follow-up visit. BCVA, macular appearance, OCT and FA findings were used to decide if the subject should have received another intravitreal injection of aflibercept. A decrease in BCVA, aggravation of metamorphopsia, presence of macular oedema or haemorrhage, increased central retinal thickness (CRT) or central macular thickness (CMT), or increased leakage created the need for additional treatment with aflibercept.

Statistical analysis

Statistical analysis using SPSS version 26.0 (IBM Corp.). All values in the text are presented as the mean ± standard deviation. The outcomes at different time-points following treatment were compared with baseline values of BCVA and CRT individually. Pairwise comparisons were performed at different postoperative time-points. The data were evaluated for normality using normality tests. Normally distributed data were assessed using repeated-measures ANOVA and pairwise comparisons were performed using Friedman's test. Homogeneity of variance was tested prior to ANOVA. Non-normally distributed data were assessed using the Kruskal-Wallis H-test. Dunn's test was used for pairwise comparisons. P<0.05 was considered to indicate a statistically significant difference.

Results

Patient disposition, baseline characteristics and exposure

All 16 eyes were administered an aflibercept intravitreal injection. Basic information of the two groups is provided in Table I. Follow-up images were obtained at 1, 2, 4, 6, 8, 10 and 12 months after treatment. None of the patients developed glaucoma following the high-dose aflibercept injection and intraocular pressure (IOP) in all eyes was controlled at <21 mmHg at each visit. During the follow-up period, no cardiovascular or cerebrovascular embolism and no death events were recorded.

Table I

Baseline demographic and clinical characteristics (patients, n=16; eyes, n=16).

Table I

Baseline demographic and clinical characteristics (patients, n=16; eyes, n=16).

CharacteristicValue
Gender 
     Male7
     Female9
Age, years30.5±3.35
Spherical equivalent, D-7.31±0.90
Axial length, mm27.17±0.89
Duration of symptoms, months0.96±0.67
Number of injections2.13±0.5
Follow-up duration, months13.41±1.17

[i] Data are presented as n or mean ± standard deviation.

Key outcomes

The Snellen BCVA was changed into a logarithm of the minimum angle of resolution (logMAR). The changes in BCVA and CRT reached statistical significance at the 1-, 2-, 4-, 6-, 8-, 10- and 12-month follow-ups compared with the baseline. The mean BCVA improved from 0.35±0.15 logMAR at the baseline to 0.12±0.05 logMAR at the final follow-up (P<0.05; Fig. 1). The reduction in metamorphopsia was obvious. The mean CRT at the last follow-up was reduced from 345.38±34.69 µm (pre-treatment levels) to 222.75±8.98 µm (P<0.05; Fig. 2). There was a significant difference in BCVA at 12 months after surgery compared with the 1-month follow-up (P<0.05). There were significant differences in CRT at the 2-, 4-, 6-, 8-, 10- and 12-month follow-ups, as compared with the 1-month follow-up after the initial injection (P<0.05). In addition, significantly different changes were observed at 4-months of follow-up compared with the 2-month follow-up. Most of the retinal fluid was absorbed and the choroidal neovascularization was diminished within the subretinal space. The favourable results of the present study strengthened the confidence in the efficacy of high-dose aflibercept for mCNV treatment.

Case of a patient

Fig. 3A-G presents the changes in the OCT scan of a representative patient (female, 29 years old) diagnosed with mCNV during the follow-up. At diagnosis, OCT indicated fibrovascular pigment epithelial detachment and increased retinal thickness in the fovea. The BCVA was 0.9 logMAR. At one month after the initial injection, the fibrovascular pigment epithelial detachment had partially retreated and the retinal thickness decreased from 341 µm (pre-treatment levels) to 221 µm. A strong dot reflection may be seen at the top. The BCVA was 0.4 logMAR. After the second aflibercept 4 mg injection, the OCT scan showed that the neovascularization further retreated. It was observed that the neovascularization gradually subsided, the retinal thickness returned to normal, the morphology of the macular fovea was almost normal in late follow-ups and the BCVA was improved and stable. The BCVA was 0.3, 0.3, 0.2, 0.1 and 0.1 logMAR at 2, 4, 6, 8 and 12 months, respectively, following the initial aflibercept injection (data not shown).

Discussion

mCNV is one of the sight-threatening complications of PM. The application of anti-VEGF drugs in choroidal neovascularization of high myopia has markedly improved the visual quality of patients, particularly the working population. Among the anti-VEGF drugs, bevacizumab and ranibizumab exhibited a similar efficacy in restoring functional and anatomical parameters. However, ranibizumab was designed and approved for ocular administration. It appears to be the preferred treatment for mCNV, as it achieves efficacy with a short treatment duration and frequency and few adverse effects (10,23). Aflibercept as a new generation of anti-VEGF agent was originally approved for the treatment of AMD. Fauser and Muether compared the VEGF suppression times in their study on AMD treatment and reported that aflibercept has significantly longer VEGF suppression times compared with ranibizumab (24).

There is now substantial evidence in favour of the use of aflibercept for mCNV. Toto et al (7) reported the most recent data from the articles of anti-VEGF therapy for mCNV. In their study on intravitreal aflibercept injection for mCNV, Chen et al (25) found that a single aflibercept 2.0 mg injection resolved mCNV in ~50% of the patients. The median number of injections was two within 12 months. Another prospective 12-month cohort study reported promising results; the efficacy of the intravitreal aflibercept (2 mg) 2+PRN regimen in 31 eyes of 30 patients with mCNV was evaluated and the mean decimal BCVA improved from 0.2±0.1 at the baseline to 0.35±0.16 at the 12-month follow-up (23). In addition, studies showing the efficacy of the initial dosing regimens, such as the 1+PRN and 3+PRN regimens, indicated no statistically significant difference in BCVA. In a retrospective study, Kung et al (26) reported that there was no significant difference in visual improvement between the eyes with a single intravitreal injection and the eyes with a loading dose of 3 monthly injections . The mean number of injections was 2.32 and 3.57, respectively. Korol et al (27) reported a series of 47 eyes with 24-month follow-up in which there was an increase in BCVA and decrease in central foveal thickness. The total mean number of injections in their study was 2.8±1.1. In another study by our group on mCNV treatment using conbercept, it was found that the effect of one injection was not ideal; the CRT was 261.50±21.66 µm at 1 month after the first injection and 247.06±23.85 µm at 1 month after the second injection (28). Furthermore, the mean CNV area was 0.22 mm2 at 1 month after the first injection and was 0.07 mm2 at 1 month after the second injection.

The outcomes of 16 consecutive eyes with mCNV treated with 4 mg aflibercept intravitreal injection were retrospectively reviewed and followed up for 12 months. All eyes initially underwent two injections 35 days apart, followed by an additional injection based on monthly visits. The present study revealed several clinical effects of the intravitreal injection of aflibercept in the treatment of mCNV. The BCVA improved from 0.35±0.15 logMAR at the baseline to 0.12±0.05 logMAR at the final follow-up visit. The BCVA improved significantly 1 month after the initial injection and further after the second injection. There was a significant difference in BCVA at 1 and 12 months after surgery. An ideal visual acuity was achieved and remained stable after two injections. The CRT was decreased significantly from 345.38±34.69 to 296.88±28.93 µm at 1 month after the initial injection. At 2 months after treatment, the CRT reached 255.31±24.25 µm. At 4 months from surgery, the CRT was further reduced and reached 234.56±10.74 µm. The CRT remained stable and was 222.75±8.98 µm at the 12-month follow-up visit. In the present study, the CRT reached stable levels at 2 and 4 months after the initial injection. This outcome is different from what was previously reported in the MYRROR trial (16). The MYRROR trial, which adopted an as-needed aflibercept treatment for mCNV, indicated that the CMT rapidly decreased and reached stable levels between weeks 4 and 8. Such an early improvement of CMT was consistent with another retrospective clinical study, which compared bevacizumab to aflibercept in the treatment of mCNV (29). At week 48, in the MYRROR trial, the decrease in CRT was 86.2 µm, whereas in the present study, it was 122.63 µm (16). Furthermore, in the present study, aflibercept had significant advantages in terms of the VEGF suppression times in the treatment of mCNV. Only 3/16 mCNV cases were injected for the third time and the mean number of injections during the 12-month follow-up was 2.13±0.5, which was lower than that in other studies (23,26,27,30). In the present study, it was found that the 4 mg aflibercept 2+PRN scheme was able to markedly eliminate neovascularization. In addition, none of the cases had any recurrence or significant increase in CRT, while the visual acuity remained stable during the 12-month follow-up. The present results showed that aflibercept may represent an ideal choice for mCNV treatment. Following the diagnosis of mCNV, a timely intravitreal injection of aflibercept may provide an improved curative effect.

As with any common intraocular surgery, intravitreal injections of anti-VEGF drugs are accompanied by risks of bleeding, infection, cataracts and glaucoma (31). Elevated IOP and ocular inflammation following intravitreal injection are the most frequently reported serious ocular adverse events (32). Therefore, a comprehensive ophthalmic examination should be performed in subjects with mCNV prior to intravitreal injections. In the present study, no systemic or ocular safety issues were noted in any of the patients treated with high-dose aflibercept. No cases of increased IOP or intraocular inflammation were noted in patients treated with 4 mg aflibercept. The safety and efficacy of high-dose therapy for mCNV needs to be confirmed by large-scale and rigorous clinical trials.

There were several limitations to the present study that may impact or influence the interpretation and generalizability of the findings. First, due to the retrospective design, the lack of randomization somewhat reduced the power of the results. Furthermore, the outcomes should be interpreted with caution due to the small sample size. As another limitation, the study lacked a control group. In addition, the follow-up time was short (12 months) and continuous follow-up is necessary. The present study also has its advantages. To the best of our knowledge, this is the first clinical observation obtained using high-dose aflibercept (4 mg) in the treatment of mCNV. According to these results, the 4 mg aflibercept 2+PRN scheme proved effective for mCNV, but future studies, require to be conducted in order to further evaluate the effect of this scheme.

In conclusion, the present study indicated that an intravitreal injection of high-dose aflibercept (4 mg 2+PRN scheme) was effective in promoting vision improvement and stabilization. It also significantly alleviated metamorphopsia and reduced the CRT in patients with mCNV. During the 12-month follow-up, the BCVA and CRT were stable. The present results suggested that the aflibercept 4 mg 2+PRN scheme may be an ideal choice for mCNV treatment, prompting further studies to evaluate the effect of this regimen.

Acknowledgements

Not applicable.

Funding

Funding: No funding was received.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Authors' contributions

WZ and CH designed the study and drafted and revised the manuscript. YH and ZY performed data acquisition, analysis and interpretation. All authors have read and approved the final manuscript. CH and WZ confirm the authenticity of all the raw data.

Ethics approval and consent to participate

This study followed the tenets of the Declaration of Helsinki and was approved by the ethics committee of the Central Hospital Affiliated to Shandong First Medical University (Jinan, China; approval no. 2022-130-01). Written informed consent was obtained from all patients.

Patient consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

References

1 

Neelam K, Cheung CM, Ohno-Matsui K, Lai TY and Wong TY: Choroidal neovascularization in pathological myopia. Prog Retin Eye Res. 31:495–525. 2012.PubMed/NCBI View Article : Google Scholar

2 

Wong TY, Ferreira A, Hughes R, Carter G and Mitchell P: Epidemiology and disease burden of pathologic myopia and myopic choroidal neovascularization: An evidence-based systematic review. Am J Ophthalmol. 157:9–25.e12. 2014.PubMed/NCBI View Article : Google Scholar

3 

Ohno-Matsui K, Yoshida T, Futagami S, Yasuzumi K, Shimada N, Kojima A, Tokoro T and Mochizuki M: Patchy atrophy and lacquer cracks predispose to the development of choroidal neovascularization in pathological myopia. Br J Ophthalmol. 87:570–573. 2003.PubMed/NCBI View Article : Google Scholar

4 

Wakabayashi T and Ikuno Y: Choroidal filling delay in choroidal neovascularization due to pathological myopia. Br J Ophthalmol. 94:611–15. 2010.PubMed/NCBI View Article : Google Scholar

5 

Ikuno Y, Jo Y, Hamasaki T and Tano Y: Ocular risk factors for choroidal neovascularization in pathologic myopia. Invest Ophthalmol Vis Sci. 51:3721–3725. 2010.PubMed/NCBI View Article : Google Scholar

6 

Grossniklaus HE and Green WR: Pathologic findings in pathologic myopia. Retina. 12:127–133. 1992.PubMed/NCBI View Article : Google Scholar

7 

Toto L, Di Antonio L, Costantino O and Mastropasqua R: Anti-VEGF therapy in myopic CNV. Curr Drug Targets. 22:1054–1063. 2021.PubMed/NCBI View Article : Google Scholar

8 

Ehrlich R, Kramer M, Rosenblatt I, Weinberger D, Mimouni K, Priel E and Axer-Siegel R: Photodynamic therapy for choroidal neovascularization in young adult patients. Int Ophthalmol. 30:345–351. 2010.PubMed/NCBI View Article : Google Scholar

9 

Sickenberg M, Schmidt-Erfurth U, Miller JW, Pournaras CJ, Zografos L, Piguet B, Donati G, Laqua H, Barbazetto I, Gragoudas ES, et al: A preliminary study of photodynamic therapy using verteporfin for choroidal neovascularization in pathologic myopia, ocular histoplasmosis syndrome, angioid streaks and idiopathic causes. Arch Ophthalmol. 118:327–336. 2000.PubMed/NCBI View Article : Google Scholar

10 

Cohen SY: Anti-VEGF drugs as the 2009 first-line therapy for choroidal neovascularization in pathologic myopia. Retina. 29:1062–1066. 2009.PubMed/NCBI View Article : Google Scholar

11 

Teo KY, Ng WY, Lee SY and Cheung CM: Management of myopic choroidal neovascularization: Focus on anti-VEGF therapy. Drugs. 76:1119–1133. 2016.PubMed/NCBI View Article : Google Scholar

12 

Ferrara N, Damico L, Shams N, Lowman H and Kim R: Development of ranibizumab, an anti-vascular endothelial growth factor antigen binding fragment, as therapy for neovascular age-related macular degeneration. Retina. 26:859–870. 2006.PubMed/NCBI View Article : Google Scholar

13 

Laud K, Spaide RF, Freund KB, Slakter J and Klancnik JM Jr: Treatment of choroidal neovascularization in pathologic myopia with intravitreal bevacizumab. Retina. 26:960–963. 2006.PubMed/NCBI View Article : Google Scholar

14 

Howaidy A and Eldaly ZH: Comparison of structural and functional outcome of aflibercept versus ranibizumab in patients with myopic choroidal neovascularization. Eur J Ophthalmol. 31:211–217. 2021.PubMed/NCBI View Article : Google Scholar

15 

Wu Z, Zhou P, Li X, Wang H, Luo D, Qiao H, Ke X and Huang J: Structural characterization of a recombinant fusion protein by instrumental analysis and molecular modeling. PLoS One. 8(e57642)2013.PubMed/NCBI View Article : Google Scholar

16 

Ikuno Y, Ohno-Matsui K, Wong TY, Korobelnik JF, Vitti R, Li T, Stemper B, Asmus F, Zeitz O, Ishibashi T and MYRROR Investigators: Intravitreal aflibercept injection in patients with myopic choroidal neovascularization: The MYRROR study. Ophthalmology. 122:1220–1227. 2015.PubMed/NCBI View Article : Google Scholar

17 

Karasu B and Celebi ARC: The efficacy of different anti-vascular endothelial growth factor agents and prognostic biomarkers in monitoring of the treatment for myopic choroidal neovascularization. Int Ophthalmol. 42:2729–2740. 2022.PubMed/NCBI View Article : Google Scholar

18 

Broadhead GK, Keenan TDL, Chew EY, Wiley HE and Cukras CA: Comparison of agents using higher dose anti-VEGF therapy for treatment-resistant neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 260:2239–2247. 2022.PubMed/NCBI View Article : Google Scholar

19 

You QS, Gaber R, Meshi A, Ramkumar HL, Alam M, Muftuoglu IK and Freeman WR: High-dose high-frequency aflibercept for recalcitrant neovascular age-related macular degeneration. Retina. 38:1156–1165. 2018.PubMed/NCBI View Article : Google Scholar

20 

Nguyen QD, Campochiaro PA, Shah SM, Browning DJ, Hudson HL, Sonkin PL, Hariprasad SM, Kaiser PK, Slakter J, Haller JA, et al: Evaluation of very high-and very low-dose intravitreal aflibercept in patients with neovascular age-related macular degeneration. J Ocul Pharmacol Ther. 28:581–588. 2012.PubMed/NCBI View Article : Google Scholar

21 

Pece A and Milani P: Intravitreal aflibercept for myopic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol. 254:2327–2332. 2016.PubMed/NCBI View Article : Google Scholar

22 

Bruè C, Pazzaglia A, Mariotti C, Reibaldi M and Giovannini A: Aflibercept as primary treatment for myopic choroidal neovascularisation: A retrospective study. Eye (Lond). 30:139–145. 2016.PubMed/NCBI View Article : Google Scholar

23 

Korol AR, Zadorozhnyy OS, Naumenko VO, Kustryn TB and Pasyechnikova NV: Intravitreal aflibercept for the treatment of choroidal neovascularization associated with pathologic myopia: A pilot study. Clin Ophthalmol. 10:2223–2229. 2016.PubMed/NCBI View Article : Google Scholar

24 

Fauser S and Muether PS: Clinical correlation to differences in ranibizumab and aflibercept vascular endothelial growth factor suppression times. Br J Ophthalmol. 100:1494–1498. 2016.PubMed/NCBI View Article : Google Scholar

25 

Chen SL, Tang PL and Wu TT: Result of intravitreal aflibercept injection for myopic choroidal neovascularization. BMC Ophthalmol. 21(342)2021.PubMed/NCBI View Article : Google Scholar

26 

Kung YH, Wu TT and Huang YH: One-year outcome of two different initial dosing regimens of intravitreal ranibizumab for myopic choroidal neovascularization. Acta Ophthalmol. 92:e615–e620. 2014.PubMed/NCBI View Article : Google Scholar

27 

Korol A, Kustryn T, Zadorozhnyy O, Pasyechnikova N and Kozak I: Comparison of efficacy of intravitreal ranibizumab and aflibercept in eyes with myopic choroidal neovascularization: 24-month follow-up. J Ocul Pharmacol Ther. 36:122–125. 2020.PubMed/NCBI View Article : Google Scholar

28 

Zhu W, Hao Y, Yuan Z, Huang C, Liu J and Ma Y: Long-term outcomes of high-dose conbercept treatment for myopic cho-roidal neovascularisation and idiopathic choroidal neovascularisation. Ophthalmic Res, Feb 6, 2023 (Epub ahead of print).

29 

Wang JK, Huang TL, Chang PY, Chen YT, Chang CW, Chen FT, Hsu YR and Chen YJ: Intravitreal aflibercept versus bevacizumab for treatment of myopic choroidal neovascularization. Sci Rep. 8(14389)2018.PubMed/NCBI View Article : Google Scholar

30 

Corazza P, Kabbani J, Soomro T, Alam MMR, D'Alterio FM and Younis S: Three-year real-world outcomes of intravitreal anti-VEGF therapies in patients affected by myopic choroidal neovascularization. Eur J Ophthalmol. 31:2481–2487. 2021.PubMed/NCBI View Article : Google Scholar

31 

Fung AE, Rosenfeld PJ and Reichel E: The international intravitreal bevacizumab safety survey: Using the internet to assess drug safety worldwide. Br J Ophthalmol. 90:1344–1349. 2006.PubMed/NCBI View Article : Google Scholar

32 

Solomon SD, Lindsley KB, Krzystolik MG, Vedula SS and Hawkins BS: Intravitreal bevacizumab versus ranibizumab for treatment of neovascular age-related macular degeneration: Findings from a cochrane systematic review. Ophthalmology. 123:70–77. 2016.PubMed/NCBI View Article : Google Scholar

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Zhu W, Hao Y, Yuan Z and Huang C: High‑dose aflibercept injection has striking effects on myopic choroidal neovascularization. Exp Ther Med 25: 301, 2023
APA
Zhu, W., Hao, Y., Yuan, Z., & Huang, C. (2023). High‑dose aflibercept injection has striking effects on myopic choroidal neovascularization. Experimental and Therapeutic Medicine, 25, 301. https://doi.org/10.3892/etm.2023.12000
MLA
Zhu, W., Hao, Y., Yuan, Z., Huang, C."High‑dose aflibercept injection has striking effects on myopic choroidal neovascularization". Experimental and Therapeutic Medicine 25.6 (2023): 301.
Chicago
Zhu, W., Hao, Y., Yuan, Z., Huang, C."High‑dose aflibercept injection has striking effects on myopic choroidal neovascularization". Experimental and Therapeutic Medicine 25, no. 6 (2023): 301. https://doi.org/10.3892/etm.2023.12000