The other CNVM: a review of myopic choroidal neovascularization treatment in the age of anti-vascular endothelial growth factor agents.

Choroidal neovascular membranes (CNVM) associated with pathological myopia (PM) can result in significant vision loss and legal blindness. These membranes usually occur subfoveally and are a major complication of PM, developing in approximately 5-10% of such eyes. PM is the second most common cause of choroidal neovascularization after age-related macular degeneration (AMD), and accounts for nearly 60% of CNVM cases in patients younger than age 50. Vascular endothelial growth factor-A has been implicated as the major angiogenic stimulus responsible for choroidal neovascularization secondary to AMD and several major studies have proved the benefits of anti-VEGF treatment for AMD-related CNVM. Benefits have also been observed in a number of prospective and retrospective studies evaluating PM CNVM. Despite the small differences in molecular properties of ranibizumab and bevacizumab, both drugs showed similar therapeutic effects for CNVM associated with PM. Many studies also highlighted that patient age, previous photodynamic therapy treatment, axial length, and visual acuity prior to treatment may affect treatment prognosis. Although there is a paucity of large randomized controlled trials, this systematic review highlights the large numbers of individual trials that demonstrate a significant improvement in VA. The inferior long-term results of alternative therapies, combined with an excellent safety profile from anti-VEGF treatment, make anti-VEGF the current recommended first-line therapy.