Factors Associated to Treatment Burden in Patients Affected by Myopic Choroidal Neovascularization

Patients affected by treatment-naive mCNV will be included in a 12-month monocentric retrospective cohort study; all patients have been treated with intravitreal anti-VEGF injections between 2020 and 2024 in the Eye Clinic Policlinico Gaspare Rodolico, (Catania, Italy). The study adheres to the tenets of the Helsinki Declaration and ita has been approved by the Institutional review board of the University of Catania (Catania 1 Local Ethical Committee). Informed consent was given by patients at the start of the treatment.

Before starting the treatment, all patients have received a complete ophthalmic examination including a best-corrected visual acuity (BCVA) test, biomicroscopic slit-lamp examination, fundus examination in mydriasis, OCT and OCTA. All patients underwent one intravitreal injection at baseline (0.5 mg ranibizumab or 2.0 mg aflibercept); additional intravitreal injections were administered over the follow-up period according to the activity signs detected (pro-re-nata treatment protocol). Any signs of activity were detected by OCT and OCTA and fluorescein angiography has been performed whenever deemed necessary. Myopic active CNV was defined by clinical (retinal haemorrage detection on fundus examination) and OCT signs (intraretinal cysts, subretinal fluid and subretinal hyperreflective exudation with fuzzy borders). Fluorescein Angiography (FA) was performed .

Clinical and imaging data of the baseline examination and of the 12-month visit (M12) after the first intravitreal injection will be collected.

Best-corrected visual acuity was tested on standard Early Treatment Diabetic Retinopathy Study (ETDRS) charts converted into logarithmic scale of the minimal angle of resolution (logMAR). OCT and FA were carried out by Spectralis HRA+OCT with a confocal scanning laser ophthalmoscope (Heidelberg Engineering, Heidelberg, Germany). The OCT scan protocol used was a 15°x15° 67-section macular cube with additional high resolution horizontal and vertical single lines centred on the CNV. AngioVue XR Avanti (Optovue Inc, Fremont, California, USA) was employed to perform OCTA. A light source of 840 nm was used and the A-scan rate was 70,000 per second with a bandwidth of 50 nm. The macula images (6mmx6mm) obtained by OCTA were centered on the foveola. Each volume contained 400x400 A-scans with two consecutive B-scans acquired in each fixed position. The split-spectrum amplitude-decorrelation angiography (SSADA) method was used to capture the dynamic motion of red blood cells. mCNV areas were selected manually using AngioAnalytics software on the outer retina slab.

The values of the "CNV select area" will be included in the analysis as mCNV size. The Central Macular Thickness (CMT, micron) automatically provided by the machine, will be collected.