Is ellipsoid zone integrity essential for visual recovery in myopic
neovascularization after anti-VEGF therapy?
Received: 3 March 2017 /Revised: 15 May 2017 /Accepted: 30 May 2017 /Published online: 30 June 2017
Springer-Verlag Berlin Heidelberg 2017
Purpose To evaluate functional prognostic factors and
neuroretinal changes after anti-vascular endothelial growth
factor (VEGF) treatment in patients with naïve, recent myopic
neovascularization (mCNV), as assessed by spectral-domain
optical coherence tomography (SD-OCT).
Methods Specific changes in tomographic features between
baseline and final follow-up were retrospectively evaluated
by two examiners independently. Imaging was obtained by a
multi-modal imaging system which combines fluorescein an-
giography and SD-OCT.
Results Twenty-two eyes (male, six; female, 16; mean age,
65 ± 14 years) were considered. Mean follow-up was
21.5 ± 14 months. Best-corrected visual acuity (BCVA) im-
proved from 0.38 ± 0.26 to 0.16 ± 0.20 logMAR (p <0.001).
The ellipsoid zone and the external limiting membrane (ELM)
were disrupted in 21 (95.5%) and 15 (68.2%) eyes at baseline,
and in 16 (72.7%) and nine (40.9%) eyes after therapy respec-
tively. The ellipsoid zone and ELM were typically intact at
lesion margins in 13 (59.1%) and 19 eyes (86.5%) respectively
at baseline. The inner retina was intact in 20 eyes (91%). Six
eyes (27.3%) exhibited complete regression without fibrosis.
Absence of hemorrhage and integrity of lesion-adjacent ELM
and of lesion-adjacent ellipsoid zone at baseline were factors
forbetterfinalBCVA(p ≤ 0.05)
Conclusion Vision gain might occur despite ellipsoid zone or
ELM restoration. Hemorrhage could be considered a negative
prognostic factor, integrity of lesion-adjacent ELM and of
lesion-adjacent ellipsoid zone as positive prognostic factors.
Myopic CNV can also resolve completely without fibrosis.
Keywords Myopic neovascularization
Myopic choroidal neovascularization (mCNV) is a classic
type 2 lesion  with a neovascular network spreading from
the choriocapillaris through the retinal pigment epithelium
(RPE) towards the neuroretina. In comparison with neovascu-
larization associated with age-related macular degeneration
(AMD), mCNV exhibits unique features on fluorescein angi-
ography (FA) and spectral-domain optical coherence tomog-
raphy (SD-OCT)  and typically requires fewer treatments
. It has been reported that 5.2–11.3% of subjects with high
myopia develop mCNV , which usually presents good
prognosis after intravitreal anti-vascular endothelial growth
factor (VEGF) therapy [5–7].
Several descriptions of the tomographic features of naïve
mCNV exist in literature [8–11]. Naïve mCNV usually pre-
sents as a small lesion, with infrequent hemorrhage and retinal
fluid accumulation. It may be visualized as a hyper-reflective
lesion above the RPE, mainly involving the external segments
of the retina and causing a corresponding retinal thickening.
However, macular neuroretinal layers changes following anti-
* Paolo Milani
Ophthalmology Department, Istituto Auxologico Italiano, Via Stefini
10, 20125 Milan, Italy
Eye Clinic, Biomedical and Clinical Sciences Department, Luigi
Sacco Hospital, University of Milan, Milan, Italy
Statistics and Quantitative Methods Department, University of
Milano-Bicocca and Istituto Auxologico Italiano, Milan, Italy
Graefes Arch Clin Exp Ophthalmol (2017) 255:1713–1720