Perforating Scleral Vessels and Their Influence on Myopic Macular Neovascularization

To evaluate the relationship between the presence and spatial relationship of perforating scleral vessels (PSVs) to the neovascular membrane, as seen on spectral-domain optical coherence tomography (SD-OCT), in eyes with myopic macular neovascularization (mMNV), and their association with clinical, anatomical, and treatment-related features.

This retrospective case series included patients from the Portuguese Retina Study Group registry (Retina.com.pt) with a diagnosis of mMNV and active follow-up at ULS-SJ. Clinical data were collected and SD-OCT macular scans reviewed to determine PSV presence and spatial relation to the neovascular membrane.

We analyzed 100 eyes from 83 patients. PSVs were identified in 69 eyes (69%), and in 47 of these (68%), they were in direct contact with the neovascular membrane. PSV presence was significantly associated with older age (p = 0.019, Cohen's d = -0.57), thinner choroid (p < 0.001, r = -0.34), and greater macular thickness at diagnosis (p = 0.009, Cohen's d = -0.58). It was also associated with a higher likelihood of anti-VEGF treatment switch (OR = 7.44, p = 0.022), but not with recurrence (OR = 1.30, p = 0.806), injection frequency (p = 0.258), or change in visual acuity (p = 0.093, r = 0.17). PSV-lesion contact was associated with older age (mean: 60.9 vs 49.8 years, p < 0.001, Cohen's d = 0.83) and thinner choroid (mean rank: 39.98 vs 56.02, p = 0.005, r = 0.29).

PSVs were frequently observed in eyes with mMNV and were associated with older age, thinner choroid, and greater macular thickness at baseline, as well as a higher likelihood of requiring treatment switch. However, neither their presence nor lesion contact independently predicted a worse disease course or functional outcome.