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Myopic Choroidal Neovascularization: Review, Guidance, and Consensus Statement on Management

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  • Chui Ming Gemmy Cheung
  • Jennifer J Arnold
  • Frank G Holz
  • Kyu Hyung Park
  • Timothy Y Y Lai
  • Michael Larsen
  • Paul Mitchell
  • Kyoko Ohno-Matsui
  • Shih-Jen Chen
  • Sebastian Wolf
  • Tien Yin Wong
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TOPIC: The aim of this article is to review and compile available information on the classification, pathophysiology, and clinical features of myopic choroidal neovascularization (CNV); to describe the latest data on the management of this disease; and to present guidance.

CLINICAL RELEVANCE: In the United States, myopia affects approximately 34 million people (2010), and similar figures have been reported in Europe. Pathologic myopia (PM), a possible consequence of myopia, is estimated to affect up to 3% of the global population. One of the most serious complications of PM is myopic CNV, which often leads to a sudden onset but progressive decline in central vision and is associated with a poor prognosis unless treated. Furthermore, 35% of patients with myopic CNV develop bilateral disease in the fellow eye within 8 years. Although intravitreal anti-vascular endothelial growth factor (VEGF) therapies have had a major impact on the management of patients with myopic CNV, there remain significant gaps in our understanding of this condition and how to best administer treatment. Additionally, the long-term safety and efficacy of these treatments are largely unknown.

METHODS: We carried out a literature review (September 2015) of all English-language articles in PubMed resulting from searches of the following terms: "choroidal neovascularization" AND "myopia" OR "myopic macular degeneration" OR "degenerative myopia" OR "myopic maculopathy" OR "myopic retinopathy" OR "pathological myopia" OR "pathologic myopia."

RESULTS: We screened a total of 566 abstracts, and 250 articles were deemed relevant for full publication review. We excluded a further 71, but an additional 44 articles were identified. This resulted in 223 articles being used to develop this review.

CONCLUSIONS: Highly myopic patients experiencing a sudden loss of central vision should be referred for further examination. Once a diagnosis of myopic CNV has been confirmed, after fluorescein angiography, treatment initiation should be prompt and anti-VEGF agents considered as first-line therapy, unless contraindicated. Continued monitoring of patients is required to assess any progression or recurrence of the condition.

Original languageEnglish
JournalOphthalmology
Volume124
Issue number11
Pages (from-to)1690-1711
Number of pages22
ISSN0161-6420
DOIs
Publication statusPublished - 2017

    Research areas

  • Angiogenesis Inhibitors, Choroidal Neovascularization, Consensus, Databases, Factual, Disease Progression, Fluorescein Angiography, Humans, Myopia, Degenerative, Practice Guidelines as Topic, Visual Acuity, Journal Article, Review

ID: 52800230