Myopic Macular Neovascularization Complications May Reduce Visual Acuity

Fibrosis and macular atrophy are common complications in patients with myopic macular neovascularization (mMNV) who receive anti-vascular endothelial growth factor (anti-VEGF) treatments, according to research published in Ophthalmology Retina. Despite initially successful treatment, these complications may have detrimental effects on best-measured visual acuity (BMVA), according to the report. 

Researchers retroscopically reviewed data from 292 patients (313 eyes) with mMNV (mean age, 62±13.7 years; 69% women; mean refraction, -10.4±4.1 diopters (D)) presenting to a single center between January 2009 and March 2021. All patients were treated with anti-VEGF injections and underwent optical coherence tomography (OCT) imaging and visual acuity measurements over the course of the study.  

At 5 years, fibrosis incidence was 34%. A total of 10 participants had fibrosis at baseline, while an additional 87 developed it over the course of the study. Macular atrophy occurred in 26% of eyes, and macular hole (MH) was present in 8%. Among eyes with macular atrophy (n=83), 17 eyes had the condition at baseline, while 66 developed it over the study duration. 

Overall, BMVA improved from 0.45±0.37 to 0.37±0.33 logMAR during the first year (P <.001). By year 3, BMVA was 0.38±0.37 logMAR and worsened to baseline values within the fourth year of follow-up (0.47±0.47 logMAR). BMVA worsened in eyes with fibrosis from baseline (0.40±0.35 to 0.57±0.37 logMAR) and experienced a more rapid visual acuity loss than eyes without fibrosis. Patients with macular atrophy had similar BMVA at baseline, 6 months, and 1 year compared with individuals without macular atrophy. However, patients with macular atrophy experienced worsening vision from the second follow-up year (P <.05). 

“[C]linicians and patients should be aware that complications may occur after treatment of mMNV, especially in the presence of risk factors,” according to the researchers. “Non-foveal mMNV location, less severe myopic maculopathy stage, and better control of mMNV activity were associated with uncomplicated mMNV regression and better prognosis. Fibrosis and atrophy were frequent medium-term and long-term complications, respectively; both had negative effects on visual acuity.” The study authors assert that a “knowledge of mMNV-related complications may be of help for future treatments to mitigate the risk of sight-threatening outcomes.”

Study limitations include unevenly spaced visits, the lack of a control group, a retrospective nature, single center design, and possible attrition bias.

Reference

Cicinelli MV, La Franca L, De Felice E, et al. Long-term incidence and risk factors of macular fibrosis, macular atrophy, and macular hole in eyes with myopic neovascularization. Ophthalmol Retina. Published online June 27, 2022. doi:10.1016/j.oret.2022.06.009