Intravitreal Anti-VEGF Treatment of Myopic Choroidal Neovascularization: Visual Acuity Improves When Treatment Is Initiated Prior to the Development of Fibrosis or Atrophy

Purpose: To determine whether the presenting clinical features of active myopic choroidal neovascularization (CNV), including the presence of fibrosis or atrophy, limit the ultimate visual acuity gains from intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. Methods: A retrospective analysis of 42 eyes with new-onset subfoveal CNV was performed. Only patients without concurrent age-related macular degeneration and with a spherical equivalent of at least −6.0 diopters were included in the study. All eyes received either intravitreal ranibizumab or bevacizumab injections as the primary treatment on a pro re nata basis for 1 year. Changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded. Results: The mean number of ranibizumab (18 eyes) or bevacizumab (24 eyes) injections was 4.7 ± 0.5 over a mean follow-up time of 12 ± 0.4 months. The mean age of the patients was 62 ± 2.0 years. Based on optical coherence tomography staging at the initiation of treatment for active CNV, 30 had no fibrosis or atrophy (group 1), 5 had fibrotic stage, and 7 had atrophic stage CNV (the latter combined to form group 2). The BCVA for group 1 improved significantly (P < .02) but worsened for group 2 (P < .38), a statistically significant difference (P < .05). The CRT for group 1 also declined significantly more than for group 2 (P < .014). Conclusion: The presence of fibrosis or atrophy in eyes with active myopic CNV at the initiation of anti-VEGF therapy was associated with limited anatomic outcomes and visual gain.