J Korean Ophthalmol Soc.  2023 Jun;64(6):514-521. 10.3341/jkos.2023.64.6.514.

Long-term Outcomes of Myopic Choroidal Neovascularization and Retinal Changes according to ATN Classification

• Yeo S
• Kim JM

• KMID: 2542872
• DOI: http://doi.org/10.3341/jkos.2023.64.6.514

Abstract

Purpose
To evaluate the clinical outcomes of myopic choroidal neovascularization (CNV) and atrophic and tractional changes according to the ATN (A: atrophy, T: traction, N: neovascularization) classification system.
Methods
This was a retrospective review of the medical records of myopic CNV patients treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections and followed up for at least 3 years. Atrophic and tractional components were graded according to the ATN system at baseline and the last visit.
Results
The study included 21 eyes in 21 patients. The mean age was 52.29 ± 14.6 years, the mean follow-up duration was 57.65 ± 18.8 months, and the mean number of injections was 2.9 ± 1.9. Recurrence occurred in seven eyes (33.3%). Five patients (23.8%) developed myopic CNV in the contralateral eye. The mean initial and final logarithm of the minimum angle of resolution (logMAR) visual acuities were 0.44 ± 0.30 and 0.33 ± 0.39, respectively. Visual acuity was maintained or improved compared to baseline in 15 eyes (71.4%). Baseline visual acuity was significantly associated with the final visual acuity (p = 0.026). Based on the ATN classification system, the atrophic component progressed in four eyes (19.0%), while the tractional component improved in one eye (4.8%) and progressed in five eyes (23.8%).
Conclusions
Intravitreal anti-VEGF injection therapy effectively preserved long-term vision in myopic CNV patients. Evaluation of the atrophic and tractional components should not be neglected during the follow-up.

Keyword

ATN, Choroidal neovascularization, Degenerative myopia, Myopia