Morphological parameters of myopic choroidal neovascularization as predictive factors of anti-VEGF treatment response

The objective of this prospective study was to investigate the morphological changes of myopic choroidal neovascularization (mCNV) after treatment with anti-vascular endothelial growth factor and to identify potential features predictive of the final BCVA. OCT and OCTA features were evaluated at baseline and at 1, 6 and 12 months. Parameters investigated were the maturity pattern, presence of mCNV OCT activity signs, subretinal fibrosis and mCNV area. Forty patients (41 eyes) were included in the study. At the final visit, after a mean of 3.1 +/- 1.4 injections, BCVA had improved significantly (p = 0.009) and subretinal hyperreflective exudation, subretinal fluid and intraretinal cysts nearly disappeared at 12 months. At baseline, 20 eyes had an immature CNV that were smaller, required less injections (2.5 +/- 1.2 vs 3.8 +/- 1.4, p = 0.002), they completely regressed in seven eyes and achieved a better BCVA (0.14 +/- 0.15 vs 0.40 +/- 0.26 logMAR, p < 0.001) when compared to mature CNV. Subretinal fibrosis developed in 19 eyes (46.3%) with lower final BCVA than eyes without fibrosis (0.19 +/- 0.24 vs 0.38 +/- 0.22 logMAR, p = 0.012). Baseline immature pattern (p = 0.005) and baseline BCVA (p < 0.001) were predictive of final BCVA. Multimodal imaging is useful to define mCNV changes during treatment. OCTA provides prognostic information which cannot achieved by other imaging techniques.

Automated summary

This prospective study investigated the morphological changes of myopic choroidal neovascularization (mCNV) after treatment with anti-vascular endothelial growth factor and identified potential predictive features of the final best-corrected visual acuity (BCVA). The study found that immature CNV was usually smaller, required fewer treatments, and had better visual acuity improvement compared to mature CNV. Subretinal fibrosis was associated with lower final BCVA. Baseline immature pattern and baseline BCVA were predictive of final BCVA. Multimodal imaging, including OCTA, was useful in monitoring mCNV changes during treatment.