Predictive Factors for Macular Atrophy in Patients with Treated Myopic Macular Neovascularization

Macular atrophy represents an end-stage of myopic maculopathy. This study aims to identify predictive factors for atrophy growth in patients with treated myopic macular neovascularization (mMNV).

Retrospective study including 98 eyes from 83 patients registered in the national database of retinal diseases and followed and treated for mMNV for at least 2-years at our tertiary center. Our primary outcomes were the increase in the chorioretinal atrophic area (CRA) and final best corrected visual acuity (fBCVA).

Most patients (n=55, 56.1%) successfully stopped treatment after 3+pro re nata (3+PRN) (mean 6.8±5.3 intravitreal injections, IVI), while 27 patients (27.6%) required uninterrupted treat and extend (T&E) regimen (mean 27±15.46 IVI). BCVA improved from 47.18±23.06 to 58.66±21.27 ETDRS letters after mMNV treatment, over a mean of 6.04±4.1 years [2-15]. There was a 16.9% larger final mean CRA and a mean growth of 0.48±1.17mm²/year, significantly associated with worse fBCVA in the subfoveal atrophy group (39.10±28.08, p<0.001) and negatively correlated with the initial subfoveal choroidal thickness (SCT) (r=-0.31, p=0.004). The baseline CRA was the major determinant of a larger final CRA (β=0.90, p<0.001). Patients under uninterrupted T&E showed a higher CRA growth rate (0.95±1.87mm²/year, p=0.0076).

Macular atrophy after mMNV leads to irreversible visual loss. The baseline atrophic area predicts final macular atrophy. Initial SCT and the implemented treatment regimen (especially with a higher number of IVI) influence atrophy growth, although not significant in the multivariable model.