The correlation of atrophy, traction and neovascularization in myopic choroidal neovascularization according to a novel myopic maculopathy classification system (atrophy (A), traction (T), neovascularization (N): ATN).

Purpose: To grade myopic choroidal neovascularization (CNV) patients according to the new myopic maculopathy classification (A: atrophy, T: traction, N: neovascularization-ATN) and analyze the correlation in between atrophy, traction and neovascularization.

Methods: Fifty-one eyes of 41 patients with the diagnosis of pathologic myopia and myopic CNV were included in this clinical practice study. Patients were graded according to the recently described ATN classification. Color fundus photographs were used to grade the atrophy and spectral domain optical coherence tomography scans were used to grade traction and neovascularization. Active myopic CNVs were treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. Chi-square test was used to test the categorical variants and univariate logistic regression analysis was used to predict the independent risk factors of myopic CNV scar formation.

Results: Active myopic CNV was observed most frequently in the group with patchy chorioretinal atrophy. Grade of the atrophy and female gender were significantly associated with myopic CNV scar in the univariate logistic regression tests. Multivariate logistic regression showed that atrophy grading is the independent predictor of myopic CNV scar.

Conclusion: ATN classification is a practical and comprehensive system to grade myopic CNV. Atrophy is an independent predictor for myopic CNV scar and patchy chorioretinal atrophy requires a more careful examination and close follow-up for the risk of CNV development.