Myopic choroidal neovascularisation
Reviewed by Jonathan Chan

This is a review article summarising the latest myopic CNV (choroidal neovascularisation) literature in the clinical experience and management outcomes for recommendation algorithm. The aetiology of the myopic CNV was discussed by the authors under the heading of the heredo-degenerative and haemodynamic theories for the development of myopic CNV. The diagnosis of myopic CNV was based on the clinical examination, including fundal biomicroscopy, fluorescein angiogram and optical coherence tomography (OCT). The majority of the myopic CNV presents as a classic pattern on the fluorescein angiogram. On OCT imaging the majority represents a highly refractive area above the retinal pigment epithelium – type 2 CNV with minimal subretinal fluid. Fundus autofluoresence showed the increase in the accumulative lipofuscin within the retinal pigment epithelium. Lucentis (ranibizumab) is the only licensed anti-VEGF therapy for treatment of myopic CNV. Avastin (bevacizumab) is not approved for intraocular use and evidence on its safety and efficacy profile is limited. Aflibercept (Eylea) for myopic CNV is undergoing phase III, multicentre, randomised trial at present. Recent reports on Eylea indicate sustained best corrected visual acuity gains of up to 12 months. The authors recommend a treatment algorithm for myopic CNV. After initial assessment prompt treatment with a single intravitreal injection of anti-VEGF therapy is recommended due to the superior efficacy of anti-VEGFs over other treatment modalities. After the initial injection, the patients will be monitored monthly for months one and two and then at least three-monthly in the first year. If patients have positive activity or visual loss then they will have a repeat injection. After one year, the monitoring frequency should be established by the retinal specialist in consultation with the patient and the patient should be advised to return if they experience any drop in vision. 

Myopic choroidal neovascularisation: current concepts and update on clinical management.
Wong TY, Ohno-Matsui K, Leveziel N, et al.
BRITISH JOURNAL OF OPHTHALMOLOGY
2015;99:289-96.