Myopic CNV

1. Diagnosis Myopic
Neovascularization

2. Clinical Characteristics
Visual Loss
Scotomata
Distortion of Vision
Spaide, R.F., Ohno-Matsui, K. and Yannuzzi, L.A. (2021) Pathologic myopia. Cham, Switzerland: Springer.

3. Advanced Myopic Degeneration
Prior impairments vision from :
• Lacquer cracks : Mechanical dehiscence of Bruch’s membrane occurs,
produce thin branching lines in the posterior pole
• Atrophy : translucent defects with clearly discernible underlying
choroidal vessels
• Staphyloma
Spaide, R.F., Ohno-Matsui, K. and Yannuzzi, L.A. (2021) Pathologic myopia. Cham, Switzerland: Springer.

4. Clinical Finding
Sub or Intraretinal
Fluid
Subretinal
Hemorrhage
Elevation and
Infiltration of the outer
retina
Localized area of
Pigmentary Change
2022-2023 BCSC: Basic and clinical science course 12 Retina and Vitreous (2022). San Francisco: American Academy of Ophthalmology.

5. Progression of Myopic CNV
INITIALDirect Damage to
Photoreceptors
Vision Loss
THEN
CNV regresses, a
Fibrous
Pigmented Scar is
formed.
END
Chorioretinal
atrophy develops
around the
regressed CNV,
Results Poor Long
Term Visual
Outcome.
Myopic CNVM (2022) EyeWiki. Available at: https://eyewiki.aao.org/Myopic_CNVM (Accessed: February 15, 2023).

6. Diagnostic

7. Fluorescein Angiography

8. Fluorescein Angiography
Demonstrates the Vascular Ingrowth  Early Hyperfuorescence with
variable amounts of leakage later in the angiographic sequence
Fluorescein angiography showed a
hyperfuorescent lesion consistent with
choroidal neovascularization
Spaide, R.F., Ohno-Matsui, K. and Yannuzzi, L.A. (2021) Pathologic myopia. Cham, Switzerland: Springer.

9. The fuorescein angiogram shows a
hyperfuorescent lesion seen early with
pronounced leakage consistent with type 2
neovascularization
In the choroidal phase, more details of vessels are visible due to thinning of overlying RPE  Well-defined
hyperfluorescence often with a hypofluorescent rim of pigmentation in the early phase with progressive leakage
of dye in the late phase of the angiogram.
A rim of subretinal hemorrhage is seen along the area of CNVM which causes blocked fluorescence.
Spaide, R.F., Ohno-Matsui, K. and Yannuzzi, L.A. (2021) Pathologic myopia. Cham, Switzerland: Springer.

10. Early phase  Early visualization of the
vascular network. Note the separation between
the vessels and the hypopigmented area
Later phase  Leakage from the vessels, which
is another angiographic characteristic required
to make the diagnosis of classic choroidal
neovascularization.
Spaide, R.F., Ohno-Matsui, K. and Yannuzzi, L.A. (2021) Pathologic myopia. Cham, Switzerland: Springer.

11. Optical Coherence Tomography
(OCT)

12. Optical Coherence Tomography (OCT)
Signs Exudation  Intra-or Subretinal fluid and hyperrefective subretinal material in eyes with
myopic CNV.
OCT angiography  show the neovascularization in both the B-scan with fow overlay and the
en face sections
The infltration causes a low, fat alteration in the contour of the RPE monolayer.
The exudation and infltration cause boundary between the lesion and outer retina to become less
well-defned or “fuzzy.”
Loss of exudative manifestations, associated with the boundary becoming more welldefned
Spaide, R.F., Ohno-Matsui, K. and Yannuzzi, L.A. (2021) Pathologic myopia. Cham, Switzerland: Springer.

13. Myopic CNVM (2022) EyeWiki. Available at: https://eyewiki.aao.org/Myopic_CNVM (Accessed: February 15, 2023).
Spectral Domain-
OCT (SD-OCT)
Hyper-reflective lesions with fuzzy borders at the RPE, central ellipsoid,
and external limiting membrane.
Subretinal hemorrhage, intraretinal fluid , subretinal fluid or RPE
detachment may also be seen.
Enhanced depth imaging (EDI) enables visualization of choroid layers as
well which typically demonstrates atrophy in myopic eyes without
CNVM and fibrosis or thickening in myopic eyes with CNVM present

14. Swept Source - OCT
• For diagnosis and follow-up of myopic
CNVM.
• Chorioretinal thinning along with
subretinal membrane may be seen
• Better delineation of choroid layers is
also possible with SS-OCT.
Myopic CNVM (2022) EyeWiki. Available at: https://eyewiki.aao.org/Myopic_CNVM (Accessed: February 15, 2023).

15. OCT-A
• Helps in differentiation of the subretinal hemorrhage caused by both
CNVM and new lacquer crack formation.
• Active CNV  lacy wheel pattern, numerous tiny capillaries, a widely
anastomosed network, and a perilesional hypointense halo while
quiescent CNV are characterized by long filamentous linear large
mature looking vessels, rare anastomosis and a "dead tree"
appearance
• OCT-A successfully detecting up to 94.1% of myopic CNVs.
Myopic CNVM (2022) EyeWiki. Available at: https://eyewiki.aao.org/Myopic_CNVM (Accessed: February 15, 2023).

16. Myopic CNVM (2022) EyeWiki. Available at: https://eyewiki.aao.org/Myopic_CNVM (Accessed: February 15, 2023).