Perforating Scleral Vessels and Their Influence on Myopic Macular Neovascularization.

Purpose: To evaluate the relationship between the presence and spatial relationship of perforating scleral vessels (PSVs) to the neovascular membrane, as seen on spectral-domain optical coherence tomography (SD-OCT), in eyes with myopic macular neovascularization (mMNV), and their association with clinical, anatomical, and treatment-related features. Methods: This retrospective case series included patients from the Portuguese Retina Study Group registry (Retina.com.pt) with a diagnosis of mMNV and active follow-up at ULS-SJ. Clinical data were collected and SD-OCT macular scans reviewed to determine PSV presence and spatial relation to the neovascular membrane. Results: We analyzed 100 eyes from 83 patients. PSVs were identified in 69 eyes (69%), and in 47 of these (68%), they were in direct contact with the neovascular membrane. PSV presence was significantly associated with older age (p = 0.019, Cohen's d = -0.57), thinner choroid (p < 0.001, r = -0.34), and greater macular thickness at diagnosis (p = 0.009, Cohen's d = -0.58). It was also associated with a higher likelihood of anti-VEGF treatment switch (OR = 7.44, p = 0.022), but not with recurrence (OR = 1.30, p = 0.806), injection frequency (p = 0.258), or change in visual acuity (p = 0.093, r = 0.17). PSV-lesion contact was associated with older age (mean: 60.9 vs 49.8 years, p < 0.001, Cohen's d = 0.83) and thinner choroid (mean rank: 39.98 vs 56.02, p = 0.005, r = 0.29). Conclusion: PSVs were frequently observed in eyes with mMNV and were associated with older age, thinner choroid, and greater macular thickness at baseline, as well as a higher likelihood of requiring treatment switch. However, neither their presence nor lesion contact independently predicted a worse disease course or functional outcome.