Expert consensus on standardized diagnosis and treatment of pathologic myopia-associated macular neovascularization in China_Chinese Journal of Ocular Fundus Diseases

Authors：

 Fundus Disease Group of Ophthalmological Society of Chinese Medical Association ,  Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association

Corresponding author：

Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Email: dingxiaoyan@gzzoc.com; Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association, Email: dr_lixiaoxin@163.com

Keywords：

Pathologic myopia; Pathologic myopia-associated macular neovascularization; Clinical practice guidelines; Expert consensus

DOI：

10.3760/cma.j.cn511434-20250526-00232

Video：

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Pathologic myopia-associated macular neovascularization (MMN) is a prevalent clinical ophthalmic condition characterized by pathological changes including lacquer cracks, choroidal neovascularization, and Fuchs spots. Recent advancements in fundus imaging technologies and diagnostic equipment have provided novel perspectives and strategies for the diagnosis, staging, treatment, and follow-up of MMN. The continuous development of various anti-vascular endothelial growth factor agents has effectively preserved visual acuity in pathologic myopia-associated macular neovascularization patients. However, in the clinical practice of MMN, there are still many challenges, such as the lack of unified disease definitions and staging criteria, differences in the criteria for assessing disease activity, the absence of standardized treatment protocols, and the urgent need for optimized follow-up strategies. To address these issues, Fundus Disease Group of Ophthalmological Society of Chinese Medical Association and Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association jointly developed the Expert consensus on standardized diagnosis and treatment of pathologic myopia-associated macular neovascularization in China based on the principles of evidence-based medicine. This consensus systematically outlines the core elements of MMN diagnosis and treatment, including disease definitions and clinical staging criteria, identification of high-risk factors, diagnostic procedures, follow-up management protocols, assessment of disease activity, selection of individualized treatment strategies, criteria for re-treatment, and long-term follow-up strategies. It provides ophthalmologists at all levels with a scientifically standardized and clinically applicable guide. The consensus particularly emphasizes the implementation of precision medicine in clinical practice, and stresses that individualized treatment decisions should be made within the framework of standardized care, taking into account the patient’s visual needs, lesion characteristics, treatment response, and socioeconomic factors.

Citation： Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association. Expert consensus on standardized diagnosis and treatment of pathologic myopia-associated macular neovascularization in China. Chinese Journal of Ocular Fundus Diseases, 2025, 41(8): 579-591. doi: 10.3760/cma.j.cn511434-20250526-00232 Copy

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6. Yoshida T, Ohno-Matsui K, Yasuzumi K, et al. Myopic choroidal neovascularization: a 10-year follow-up[J]. Ophthalmology, 2003, 110(7): 1297-1305. DOI: 10.1016/S0161-6420(03)00461-5.
7. Curtin BJ, Karlin DB. Axial length measurements and fundus changes of the myopic eye[J]. Am J Ophthalmol, 1971, 71(Pt 1): 42-53. DOI: 10.1016/0002-9394(71)91092-0.
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12. Parolini B, Palmieri M, Finzi A, et al. The new myopic traction maculopathy staging system[J]. Eur J Ophthalmol, 2021, 31(3): 1299-1312. DOI: 10.1177/1120672120930590.
13. Zhang XJ, Chen XN, Tang FY, et al. Pathogenesis of myopic choroidal neovascularization: a systematic review and meta-analysis[J]. Surv Ophthalmol, 2023, 68(6): 1011-1026. DOI: 10.1016/j.survophthal.2023.07.006.
14. Ikuno Y, Sayanagi K, Soga K, et al. Lacquer crack formation and choroidal neovascularization in pathologic myopia[J]. Retina, 2008, 28(8): 1124-1131. DOI: 10.1097/IAE.0b013e318174417a.
15. Du R, Xie S, Lu H, et al. Hospital-based study of risk factors associated with development of myopic macular neovascularization in highly myopic eyes[J]. Ophthalmic Res, 2023, 66(1): 293-300. DOI: 10.1159/000527183.
16. Leveziel N, Caillaux V, Bastuji-Garin S, et al. Angiographic and optical coherence tomography characteristics of recent myopic choroidal neovascularization[J]. Am J Ophthalmol, 2013, 155(5): 913-919. DOI: 10.1016/j.ajo.2012.11.021.
17. Ren P, Lu L, Tang X, et al. Clinical features of simple hemorrhage and myopic choroidal neovascularization associated with lacquer cracks in pathologic myopia[J]. Graefe's Arch Clin Exp Ophthalmol, 2020, 258(12): 2661-2669. DOI: 10.1007/s00417-020-04778-6.
18. Cheung CM, Loh BK, Li X, et al. Choroidal thickness and risk characteristics of eyes with myopic choroidal neovascularization[J/OL]. Acta Ophthalmol, 2013, 91(7): e580-e581[2013-07-09]. https://pubmed.ncbi.nlm.nih.gov/23834717/. DOI: 10.1111/aos.12117.
19. Ikuno Y, Jo Y, Hamasaki T, et al. Ocular risk factors for choroidal neovascularization in pathologic myopia[J]. Invest Ophthalmol Vis Sci, 2010, 51(7): 3721-3725. DOI: 10.1167/iovs.09-3493.
20. Barteselli G, Lee SN, El-Emam S, et al. Macular choroidal volume variations in highly myopic eyes with myopic traction maculopathy and choroidal neovascularization[J]. Retina, 2014, 34(5): 880-889. DOI: 10.1097/IAE.0000000000000015.
21. Wolf S, Balciuniene VJ, Laganovska G, et al. RADIANCE: a randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia[J]. Ophthalmology, 2014, 121(3): 682-692. DOI: 10.1016/j.ophtha.2013.10.023.
22. Ikuno Y, Ohno-Matsui K, Wong TY, et al. Intravitreal Aflibercept injection in patients with myopic choroidal neovascularization: the MYRROR study[J]. Ophthalmology, 2015, 122(6): 1220-1227. DOI: 10.1016/j.ophtha.2015.01.025.
23. Parolini B, Palmieri M, Finzi A, et al. Myopic traction maculopathy: a new perspective on classification and management[J]. Asia Pac J Ophthalmol (Phila), 2021, 10(1): 49-59. DOI: 10.1097/APO.0000000000000347.
24. Iacono P, Battaglia Parodi M, Papayannis A, et al. Fluorescein angiography and spectral-domain optical coherence tomography for monitoring anti-VEGF therapy in myopic choroidal neovascularization[J]. Ophthalmic Res, 2014, 52(1): 25-31. DOI: 10.1159/000358331.
25. Chhablani J, Deepa MJ, Tyagi M, et al. Fluorescein angiography and optical coherence tomography in myopic choroidal neovascularization[J]. Eye (Lond), 2015, 29(4): 519-524. DOI: 10.1038/eye.2014.345.
26. García-Layana A, Salinas-Alamán A, Maldonado MJ, et al. Optical coherence tomography to monitor photodynamic therapy in pathological myopia[J]. Br J Ophthalmol, 2006, 90(5): 555-558. DOI: 10.1136/bjo.2005.085555.
27. Ding X, Zhan Z, Sun L, et al. Retinal pigmental epithelium elevation and external limiting membrane interruption in myopic choroidal neovascularization: correlation with activity[J]. Graefe's Arch Clin Exp Ophthalmol, 2018, 256(10): 1831-1837. DOI: 10.1007/s00417-018-4060-3.
28. Lai TY, Cheung CM. Myopic choroidal neovascularization: diagnosis and treatment[J]. Retina, 2016, 36(9): 1614-1621. DOI: 10.1097/IAE.0000000000001227.
29. Ohno-Matsui K, Ikuno Y, Lai TYY, et al. Diagnosis and treatment guideline for myopic choroidal neovascularization due to pathologic myopia[J]. Prog Retin Eye Res, 2018, 63: 92-106. DOI: 10.1016/j.preteyeres.2017.10.005.
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