This document discusses the use of ranibizumab (Lucentis) to treat choroidal neovascularization (CNV) secondary to pathologic myopia. It summarizes several case studies on the effects of ranibizumab treatment for myopic CNV. A series of 23 patients with myopic CNV who received ranibizumab treatment showed a mean visual acuity gain of 9.53 letters after 12 months. Most patients (77%) gained over 1 line of vision. No patients experienced moderate vision loss. The results suggest ranibizumab may effectively prevent vision loss and improve vision for CNV caused by pathologic myopia with very few needed treatments and no observed safety risks.

1. jmones@institutmacularetina.com RANIBIZUMAB in CNV secondaryto PATHOLOGIC MYOPIA Jordi Monés Institut de la Màcula i de la Retina CM Teknon, Barcelona

2. jmones@institutmacularetina.com New era of expectations in AMD from 2005 …alsoforother causes of CNV….

3. First cases reported: SystemicBevacizumab in myopic CNV: Dec 2005 jmones@institutmacularetina.com Nguyen QD, Shah S, Tatlipinar S, Do DV, Anden EV, Campochiaro PA. Bevacizumabsuppresseschoroidalneovascularisationcausedbypathologicalmyopia. Br J Ophthalmol. 2005 Oct;89(10):1368-70. No abstractavailable.

5. 75% improved>2 lines

6. 25% remainedthesame

8. Mean visual gain: 3,5 lines

10. Results at 12 months 1 dropout, 22continue ( follow-up 95%) 22 out of 23reached at leastfollow-up12m Mean visual gain: 9,53 letters, 2 lines( from 20/64 to 20/40) Mean # of treatments: 1,5 jmones@institutmacularetina.com

11. Results at 12 months Gain in naiveeyes: +12,78 letters Gain in pretreatedeyes: +7.43 letters Gain in <50 yearsold+12letters Gain in >50 yearsold+7,25 letters onlyoneinjection73%

12. Results at 12 months No moderate visual loss: 100% (22/22)

13. Results at 12 months Losslessthan 3 lines: 13% ( 3/22) Gain>0 lines87% (19/22) Gain>1 lines77% (17/22) Gain>3 lines27% (6/22)

14. Mujer 74 años, -10d, 20/125 juliol 20/125 20/64 20/50 20/64 20/50

15. Mujer 17 años -5d, 20/32 M 2,5 20/20 M 1 20/25 M 4 20/50 M 5 20/40 M 8 20/20 20/ 32

16. G varón 79 años , -15D, 20/125 20/125 20/40 20/40 20/32 20/32

17. Adverse Events No RD, no endophtalmitis No evidence of induced or exagerated atrophy 1 patient with angina, probably related to severe anemia jmones@institutmacularetina.com

18. Summary This short serie of 22 patients with 12 months follow-up suggest that PRNranibizumabmay be both effectiveinpreventing visual loss and in gainingvisual acuity in CNV 2ry to myopia Number of needed treatments may be very low, but is a must to continue follow-up for late recurrences Although impossible to obtain safety data from such a sort serie, the results suggest no specific risks for patients with pathologic myopia jmones@institutmacularetina.com