The Long-Term Evolution of Macular Retinoschisis in Eyes with Myopic Choroidal Neovascularization Treated with Anti-Vascular Endothelial Growth Factors

Background: To investigate the structural changes and visual outcomes in eyes with myopic choroidal neovascularization (mCNV) treated with anti-vascular endothelial growth factor (anti-VEGF) compared with fellow eyes over a long-term follow-up period. Methods: A retrospective paired-eye cohort study was conducted, and 51 patients (80.4% female, mean age 51.8 years) with an average follow-up duration of 32.8 months were enrolled. The study included patients with active, treatment-naïve mCNV in one eye and a fellow eye without mCNV. Final visual outcomes and macular retinoschisis (MRS) progression were compared between mCNV eyes treated with intravitreal anti-VEGF injections and fellow eyes. Baseline parameters potentially associated with MRS progression in mCNV eyes were analysed. Results: The final VA increased in mCNV eyes but remained worse than that in fellow eyes (logMAR 0.3 vs. 0.16, p = 0.037). The percentages of treated mCNV eyes and fellow eyes showing MRS progression were similar (18.6% vs. 16.3%, p = 0.782). When mCNV eyes with and without MRS progression were compared (n = 10 and 41, respectively), MRS at baseline was the only significant predictor of MRS progression (70% vs. 17.1%, p = 0.002). A greater percentage of eyes with MRS progression exhibited higher vitreomacular interface (VMI) grading at baseline, although the difference was not statistically significant (40% vs. 14.7%; p = 0.083). Conclusions: Anti-VEGF treatment in mCNV eyes did not increase the incidence of MRS compared with fellow eyes or aggravate MRS. However, the presence of MRS at baseline may increase the risk of MRS progression after treatment, and close monitoring of this subgroup is warranted.