Comparative analysis of anti-VEGF therapy for choroidal neovascularization secondary to high myopia in pseudophakic and phakic patients

To evaluate the influence of prior cataract surgery on anti-vascular endothelial growth factor (anti-VEGF) treatment outcomes in patients with choroidal neovascularization (CNV) secondary to pathological myopia (PM). This retrospective cohort study, conducted between July 2017 and December 2024, included 17 eyes of 17 PM-CNV patients with previous cataract surgery (post-cataract surgery mCNV group) and 17 eyes of 17 PM-CNV patients without prior surgery (phakic mCNV with cataract group). All patients received an initial intravitreal anti-VEGF injection (conbercept, ranibizumab or aflibercept) followed by a 1 + Pro Re Nata (PRN) regimen. Outcome measures included changes in visual acuity (logMAR) and central macular thickness (CMT) from baseline to 12 months, as well as injection frequency. Adverse events were also recorded. Baseline clinical features were balanced and comparable between the two groups, with all P values greater than 0.05. The mean number of injections was 2.47 for the post-cataract surgery mCNV group and 2.88 for the phakic mCNV group complicated with cataract. Relative to baseline, BCVA in the surgical group failed to achieve significant improvement at any follow-up time point, whereas the phakic group demonstrated a statistically significant improvement in BCVA at 6 and 12 months ( P < 0.05). However, pairwise BCVA comparisons between groups showed no significant differences at baseline or all post-treatment visits. CMT decreased significantly at 3, 6 and 12 months in both cohorts, yet the phakic group exhibited a greater reduction in CMT at all three time points, with intergroup differences reaching statistical significance ( P < 0.05). No severe ocular complications or systemic adverse events were detected during follow-up. This retrospective pilot study demonstrated that, compared to phakic patients with mCNV and cataract, patients who developed new-onset mCNV after prior cataract surgery showed no significant difference in visual prognosis at any follow-up point after anti-VEGF treatment but exhibited poorer anatomical outcomes at 3, 6, and 12 months post-treatment. However, confounding factors including cataract itself could not be ruled out in this study. Not applicable.