Importance of Optical Coherence Tomographic Angiography in Treatment of Myopic Choroidal Neovascularization

Background: Myopia is a growing health concern due to its link with high myopia complications like choroidal neovascularization (mCNV), which can lead to significant vision loss. Intravitreal anti-VEGF therapies have improved mCNV management, and imaging tools like fluorescein angiography (FA) and optical coherence tomographic angiography (OCTA) play key roles in diagnosis and monitoring. OCTA, being noninvasive and detailed, is increasingly valuable for assessing lesion characteristics and treatment response. Objective: To evaluate the morphological characteristics of mCNV by using OCTA and the subsequent modifications induced by anti-VEGF therapy with ranibizumab. Patients and methods: This prospective, cross-sectional observational study involved 20 eyes from 20 patients with active myopic CNV, conducted at Shebin Elkom Ophthalmology Hospital between September 2019 and December 2020. Patients underwent detailed ophthalmologic exams and imaging using OCT and OCTA to assess CNV characteristics and activity. Results: The study included 20 patients (mean age 54.8 years), with an equal distribution of right and left eye, and an average of 1.35 anti-VEGF injections per patient. While there was no significant change in Best Corrected Visual Acuity (BCVA) after injection (p=0.971), a significant reduction in central retinal thickness (CRT) was observed (p=0.027). Additionally, the presence of anastomosis and feeder vessels significantly decreased post-injection (both p<0.001), indicating morphological improvement. Conclusion: This study highlights the importance of OCTA in evaluating the treatment response of myopic choroidal neovascularization. While anti-VEGF injections led to significant anatomical improvements, OCTA proved to be an essential, noninvasive tool for detecting vascular changes and guiding clinical decisions.