Prognostic factors in myopic choroidal neovascularisation

Purpose To assess effects of age and baseline axial length on best‐corrected visual acuity (BCVA) in patients (pts) with myopic CNV receiving intravitreal aflibercept (IVT‐AFL). Methods MYRROR was a 48 week, double‐masked, sham‐controlled, Phase 3 multicentre study (NCT01249664). Pts were randomised 3:1 to IVT AFL or sham/IVT‐AFL (sham to Week 20 [W20]; IVT‐AFL from W24 to W48). Post hoc analyses assessed effects of baseline pt age and axial length on mean BCVA change at W24 and W48. Subgroups were based on median cut‐offs (age: ≤62 y vs >62 y; axial length: ≤28.6 mm vs >28.6 mm). Results 121 pts were analysed (IVT‐AFL, n=90 / sham/IVT‐AFL, n=31). With age ≤62 y, mean BCVA changes were 13.0/14.7 letters (W24/W48) for IVT‐AFL vs ‐0.8/ 8.1 for sham/IVT‐AFL. With age >62 y, changes were 11.1/12.2 letters for IVT‐AFL vs ‐3.6/‐1.2 for sham/IVT‐AFL. With axial length ≤28.6 mm, mean BCVA changes were 12.6/13.8 letters (W24/W48) for IVT‐AFL vs ‐2.1/1.7 for sham/IVT‐AFL. With axial length >28.6 mm, changes were 11.6/13.2 letters for IVT‐AFL vs ‐2.0/7.0 for sham/IVT‐AFL. Correlation coefficients based on age were ‐0.234 and ‐0.215 (W24/W48) (both P<0.05); coefficients based on axial length were non significant. Ocular AEs were mainly mild and occurred at a similar rate with IVT‐AFL and sham/IVT‐AFL (37.4% vs 38.7%; most common, respectively: conjunctival haemorrhage [11.0%] and punctate keratitis [12.9%]). 7 (5.7%) pts had a serious AE (all IVT‐AFL; only one SAE in study eye [macular hole]). No deaths were reported. Conclusion IVT‐AFL was well tolerated and associated with clinically meaningful BCVA improvements in pts stratified by age or baseline axial length. Treatment benefits may be greater among younger myopic CNV pts. Baseline axial length did not appear to affect outcomes.Commercial interest