Macular chorioretinal atrophy and visual outcomes in ranibizumab- or aflibercept-treated myopic choroidal neovascularization

Purpose: To investigate the predictors of macular chorioretinal atrophy, consisting of patchy atrophy (PA) at the macula and choroidal neovascularization (CNV)-related macular atrophy (CNV-MA), during treatment with ranibizumab or aflibercept for myopic CNV (mCNV) and its impact on visual outcomes.Methods: This retrospective study included 82 eyes with treatment-naive mCNV who were treated with pro re nata injections of ranibizumab or aflibercept.Results: Nine eyes (11.0%) presented with macular PA at baseline (PA group), and 73 eyes (89.0%) did not (non-PA group). VA improved during the first year in the non-PA group; a similar trend was noted in the PA group until 3 months after initial treatment. This improvement was maintained until 24 months (P < 0.001) in the non-PA group, but not in the PA group. In the PA group, macular chorioretinal atrophy progressed faster (P < 0.0001), and CNV-MA was more frequent during the 2 years of treatments (P = 0.04). Even non-PA group eyes sometimes developed CNV-MA (42% at Month 24) if they had a larger CNV and thinner subfoveal choroidal thickness at baseline, resulting in poorer visual prognosis (P < 0.01).Conclusion: Macular PA at baseline was a risk factor for CNV-MA development and was associated with poor visual outcomes.