Study Describes How Anti-VEGF Helps Maintain Vision in Myopic MNV

Macular atrophy definitions vary across studies. Establishing standardized criteria and refined definitions for the continuum between perilesional and foveal atrophy is key for further study of these atrophic phenotypes since these patterns may predict visual prognosis. These images from the study show a representative case of atrophy due to myopic MNV after anti-VEGF therapy: (A) a 73-year-old woman with an axial length of 28.85mm presented with a myopic MNV accompanied by retinal hemorrhage (white arrowhead); (B) FAF imaging shows corresponding hypoautofluorescence due to the hemorrhage; (C) five years after treatment, atrophy change confined to the area immediately surrounding the MNV lesion (white arrowheads); (D) FAF imaging demonstrated hypoautofluorescence in the same region. Photo: Sayanagi K, et al. Graefe’s Arch Clin Exp Ophthalmol 2026. Click image to enlarge. Anti-VEGF agents can improve early visual outcomes in patients with myopic macular neovascularization (MNV), but data beyond five years is scarce. Studies suggest that many of tthese patients continue to develop progressive atrophy, potentially leading to reduced vision in the long term, despite early gains. Researchers conducted a real-world study to evaluate perilesional atrophy in addition to foveal atrophy in myopic MNV eyes after anti-VEGF therapy. Their study, published earlier this week in Graefe’s Archive of Clinical and Experimental Ophthalmology, identified three distinct atrophy patterns that may play a role in vision prognosis.The retrospective study included 39 treatment-naïve eyes with myopic MNV. Patients received intravitreal ranibizumab or aflibercept. Over the five-year follow-up period, patients’ average BCVA improved significantly from baseline and remained significantly better at all time points, the researchers reported. They also observed significant decreases in central retinal thickness and central choroidal thickness from baseline.MNV-related atrophy developed in 59% of eyes and foveal atrophy developed in 38%. The researchers identified three atrophic types: perilesional (74%), patchy atrophy expansion (22%) and atrophy following subretinal hemorrhage (4%). These distinct modes of progression may reflect underlying pathophysiological processes, the authors explained in their study.Perilesional atrophy developed in older patients. The authors also reported that eyes with perilesional or foveal atrophy had worse baseline BCVA, thicker baseline central retinal thickness, larger greatest linear dimension, more frequent META-PM category 3, subfoveal MNV and more injections than eyes without atrophy. None of these remained significant in multivariate analysis, though the analysis did reveal that foveal atrophy was the strongest determinant of poor BCVA.“Taken together, our findings suggest that MNV-related atrophy represents a multifactorial, progressive and degenerative process in pathologic myopia, rather than a treatment-induced phenomenon,” the researchers concluded.Click here for the journal source. Sayanagi K, Shunto T, Fujimoto S, et al. Five-year real-world outcomes and patterns of MNV-related atrophy after anti-VEGF therapy in eyes with pathologic myopia. Graefe’s Arch Clin Exp Ophthalmol 2026. [Epub June 8, 2026]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.