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Differential diagnosis of myopic choroidal neovascularization (mCNV): insights from multimodal imaging and treatment implications

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Abstract

Purpose

The aim of this article is to conduct a comprehensive systematic review about the current understandings and differential diagnosis of myopic choroidal neovascularization (mCNV) and other several similar diseases, describing their multimodal imaging analysis, prognostic implications, and current types of management.

Methods

This systematic review was performed based on a search on the PubMed database of relevant papers regarding mCNV and other entities discussed in the paper, according to our current knowledge.

Results

Through the integration of a multimodal imaging approach, especially optical coherence tomography (OCT), along with accurate demographic and clinical assessment, it becomes possible to effectively differentiate mCNV from similar yet heterogeneous entities. These conditions include macular hemorrhage due to new lacquer crack (LC) formation, inflammatory diseases such as punctate inner choroidopathy (PIC)/multifocal choroidits (MFC) and epiphenomenon multiple evanescent white dot syndrome (Epi-MEWDS), neovascular age-related macular degeneration (nAMD), idiopathic CNV (ICNV), dome-shaped macula (DSM) with subretinal fluid, retinal pigment epithelium (RPE) humps, angioid streaks (AS), choroidal rupture (CR), and choroidal osteoma (CO). Each one of these entities will be described and discussed in this article.

Conclusion

Myopic choroidal neovascularization is a common retinal condition, especially among young individuals. Accurate diagnosis and differentiation from similar conditions are crucial for effective treatment. Multimodal imaging, particularly OCT, plays a crucial role in precise assessment. Future research should focus on defining biomarkers and distinguishing features to facilitate prompt treatment.

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Abbreviations

AMD:

Age-related macular degeneration

AS:

Angioid streaks

BM:

Bruch’s membrane

CC:

Choriocapillaris

CNV:

Choroidal neovascularization

CO:

Choroidal osteoma

CR:

Choroidal rupture

DSM:

Dome-shaped macula

EDI:

Enhanced-depth imaging

ELM:

External limiting membrane

EZ:

Ellipsoid zone

FA:

Fluorescein angiography

FAF:

Fundus autofluorescence

HM:

High myopia

iCNV:

Inflammatory CNV

ICNV:

Idiopathic CNV

ICGA:

Indocyanine green angiography

IMH:

Idiopathic macular hemorrhage

IRC:

Intraretinal cyst

LC:

Lacquer crack

MEWDS:

Multiple evanescent white dot syndrome

MFC:

Multifocal choroiditis

MNV:

Macular neovascularization

mCNV:

Myopic choroidal neovascularization

nAMD:

Neovascular AMD

NIR:

Near-infrared reflectance

OCT:

Optical coherence tomography

OCTA:

Optical coherence tomography angiography

PDT:

Photodynamic therapy

PIC:

Punctate inner choroidopathy

PM:

Pathologic myopia

PRN:

Pro re nata

PXE:

Pseudoxantoma elasticum

RD:

Retinal detachment

RPE:

Retinal pigment epithelium

SHRM:

Subretinal hyperreflective material

SD-OCT:

Spectral domain OCT

SRF:

Subretinal fluid

TTT:

Transpupillary thermotherapy

VA:

Visual acuity

VEGF:

Vascular endothelial growth factor

WSS:

White spot syndrome

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Authors and Affiliations

  1. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele-Milan, Italy

    Alessandro Feo & Mario R. Romano

  2. Ocular Immunology Unit, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy

    Luca De Simone & Luca Cimino

  3. Ocular Oncology Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy

    Martina Angi

  4. Department of Ophthalmology, Eye Unit Humanitas Gavazzeni-Castelli, Via Mazzini 11, Bergamo, Italy

    Mario R. Romano

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  1. Alessandro Feo
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Correspondence to Alessandro Feo.

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Feo, A., De Simone, L., Cimino, L. et al. Differential diagnosis of myopic choroidal neovascularization (mCNV): insights from multimodal imaging and treatment implications. Graefes Arch Clin Exp Ophthalmol (2023). https://doi.org/10.1007/s00417-023-06320-w

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