Retinal Predictors of Visual Outcome and Recurrence in Naïve Myopic Choroidal Neovascularization Patients

Purpose: To identify predictive factors for recurrence and to assess variables influencing visual acuity over time. Methods: This retrospective study analyzed 137 eyes of 128 patients with myopic choroidal neovascularization (mCNV) treated with intravitreal antivascular endothelial growth factor injections (ranibizumab or aflibercept) between June 2017 and June 2022, with a minimum 12-month follow-up. The study cohort was divided into two groups: The recurrence (R) group, which included eyes that experienced a recurrence of mCNV activity, and the nonrecurrence (NR) group, which included eyes without recurrence. Results: The R group consisted of 56 eyes, whereas the NR group included 81 eyes. Recurrence was significantly associated with lower baseline best-corrected visual acuity (BCVA) (odds ratio [OR]: 1.95; P = 0.018), higher central foveal thickness (OR: 0.922; P = 0.001), presence of retinal pigment epithelium (RPE) disruption (OR: 2.272; P = 0.022), presence of subretinal fluid (OR: 2.83; P = 0.008), CNV width (OR: 1.1; P = 0.041), and CNV height (OR: 1.3; P = 0.045). In the NR group, final BCVA was significantly influenced by age (P = 0.001), time to first injection (P = 0.021), baseline BCVA (P = 0.001), BCVA after initial therapy (P = 0.001), RPE disruption (P = 0.019), photoreceptor layer disruption (P = 0.048), and lesion thickness (P = 0.033). In the R group, 12-month BCVA correlated with baseline BCVA (P = 0.0019), number of injections (P = 0.08), RPE disruption (P = 0.027), ellipsoid zone disruption (P = 0.046), and CNV height (P = 0.084). Conclusions: Baseline clinical and imaging biomarkers are significantly associated with both recurrence risk and visual outcomes in mCNV. Early identification of these predictive factors may guide treatment strategies and optimize long-term visual prognosis.