Stabilization of Myopia–related Choroidal Neovascularization (CNV) with Classic Chinese Medicine Acupuncture after Anti-VEGF Failure: A Case Report

Stabilization of Myopia–related Choroidal Neovascularization (CNV) with Classic Chinese Medicine Acupuncture after Anti-VEGF Failure: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Stabilization of Myopia–related Choroidal Neovascularization (CNV) with Classic Chinese Medicine Acupuncture after Anti-VEGF Failure: A Case Report Xia This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8324294/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Pathologic myopia-related choroidal neovascularization (CNV) is a vision-threatening complication. Anti-vascular endothelial growth factor (VEGF) therapy is the current first-line treatment; however, some patients exhibit incomplete therapeutic response. This case report describes a middle-aged female with pathological myopia-related CNV who did not achieve stabilization after four intravitreal injections of bevacizumab (Avastin). Following an adjunctive course of classic Chinese medicine acupuncture consisting of 17 visits, optical coherence tomography (OCT) and fundus imaging demonstrated regression of exudation and stable visual acuity. This case highlights the potential role of classical Chinese medicine acupuncture in stabilizing myopic CNV when anti-VEGF therapy is insufficient and suggests a plausible integrative pathway for retinal microcirculation support. Ophthalmology pathologic myopia choroidal neovascularization classical Chinese medicine Wu Yun Liu Qi acupuncture Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Pathologic myopia (PM) is a leading cause of irreversible visual impairment worldwide, and choroidal neovascularization (CNV) represents one of its most visually destructive complications [ 1 ]. The introduction of intravitreal anti-vascular endothelial growth factor (VEGF) agents-initially bevacizumab and ranibizumab, and more recently aflibercept (Eylea) and faricimab (Vabysmo)-has substantially improved visual outcomes in myopic CNV and remains the current standard of care [ 2 , 3 ]. However, a subset of patients experience incomplete, transient, or suboptimal therapeutic responses despite appropriate treatment intervals. This highlights the ongoing need for adjunctive approaches that may enhance choroidal perfusion, reduce inflammatory signaling, or support retinal metabolic stability. Acupuncture has been explored as a complementary modality with the potential to influence ocular blood flow and neurovascular activity [ 4 , 5 ]. Additionally, recent reviews continue to underscore variability in long-term responsiveness to anti-VEGF therapy in myopic CNV, emphasizing gaps in sustained anatomical control for certain individuals [ 6 ]. Given these limitations, integrative approaches that support retinal microcirculation may offer clinical relevance. This case report describes a patient with PM-related CNV who achieved anatomical stabilization following a course of classic Chinese medicine acupuncture after limited therapeutic response to anti-VEGF therapy. The observed clinical improvements raise the possibility that classic Chinese medicine acupuncture may serve as an adjunctive option for selected cases with refractory or partially responsive myopic CNV. Case Presentation A 53-year-old female presented to an ophthalmology clinic in December 2024 with progressive blurred vision and central metamorphopsia. She was diagnosed with pathologic myopia complicated by CNV. Between December 2024 and April 2025, she received four intravitreal bevacizumab injections for recurrent CNV activity, but her condition showed no meaningful improvement. Her ophthalmic history extended back to 1999 and included previous retinal laser procedures, cataract surgery, and multiple bevacizumab injections in both eyes. Although her right eye had remained stable for several years, new CNV activity emerged in 2024, resulting in renewed visual decline. At presentation, her best-corrected visual acuity was approximately 20/200 in both eyes. Fundus examination and OCT revealed CNV-related scarring and retinal pigment epithelium changes, while fluorescein angiography indicated persistent neovascular activity. By June 2025, after reviewing serial imaging and clinical progression, her ophthalmologist determined that additional conventional treatment options were unlikely to be beneficial (Figs. 1–2). In early June 2025, the patient initiated treatment with classic Chinese medicine acupuncture, guided by the Wu Yun Liu Qi theoretical framework. Over a 12-week period (June-August 2025), she completed 17 sessions, comprising approximately one and a half treatment courses. No electroacupuncture or other modern adjunctive modalities were used. Patient Perspective The patient reported a long, challenging history of retinal disease: “I’ve had retinal problems since 1999, with laser surgery, cataract surgery, and Avastin shots in both eyes. The right eye had been stable for years until December 2024, when I developed new bleeding and central distortion.” As treatment progressed, she described improvements in functional vision: “The peripheral distortion in my left eye has improved more than the central vision, but I noticed improvement in the central area too. After my visit on Thursday (early September 2025), my vision was better than before the session. I could read the computer screen more easily, and it was a noticeable difference.” She further noted positive lifestyle changes undertaken with guidance from her acupuncture physician: “I also feel like changing the diet per your recommendations has improved my vision and helped my eyes heal.” Clinical Course With Imaging: OCT in April 2025 (pre-acupuncture) showed worsening CNV despite four bevacizumab injections (Fig. 1). By early June 2025, after two acupuncture sessions, imaging demonstrated persistent scarring and retinal irregularity, with visual acuity remaining approximately 20/200 in both eyes (Fig. 2). After approximately 12 sessions (June-July 2025), OCT revealed improved retinal contour in the right eye and stability in the left eye, with no evidence of subretinal fluid; subjectively, the patient reported decreased central distortion (Fig. 3). By early September 2025, after 17 sessions, OCT and fluorescein angiography confirmed inactive CNV, absence of subretinal fluid, and overall structural stability in both eyes (Figs. 4–5). The patient reported improved visual clarity and vision, reduced ocular dryness and better overall comfort. Discussion Myopic CNV arises from Bruch’s membrane breaks (lacquer cracks) and ischemia-induced stimulation of vascular endothelial growth factor (VEGF) [ 1 ]. Anti-VEGF therapy effectively suppresses neovascular activity but typically requires repeated intravitreal injections. The introduction of newer agents, such as aflibercept (Eylea) and faricimab (Vabysmo), has improved treatment durability; however, a subset of patients remains unresponsive [ 3 ]. Acupuncture may enhance choroidal and retinal microcirculation through autonomic modulation, nitric oxide-mediated vasodilation, and neurotrophic signaling [ 4 , 5 ]. Additional evidence suggests that acupuncture may improve ocular function more broadly, including ocular-surface-related symptoms such as dry eye [ 7 ], supporting its potential role in ophthalmic care. Functional MRI studies have demonstrated increased occipital perfusion following ocular acupoint stimulation, while a recent OCT-A-based pilot study reported improved retinal vessel density in myopic CNV patients treated with acupuncture [ 8 ]. In the present case, despite four Avastin (bevacizumab) injections, the patient’s CNV continued to progress, consistent with the limited outcomes of anti-VEGF therapy in advanced pathologic myopia. After receiving classical Chinese medicine acupuncture, both OCT and fluorescein angiography (FA) findings demonstrated stabilization, suggesting a temporary association with the intervention. Possible mechanisms include improved ocular and choroidal circulation and neurovascular modulation. Although electroacupuncture has been shown to enhance choroidal blood flow in experimental myopia models [ 5 ], this case utilized a purely classical Chinese medicine acupuncture approach, guided by the Wu Yun Liu Qi (Five Movements and Six Qi) theory [ 9 ], underscoring the clinical relevance of traditional methodology. Previous studies have explored acupuncture for age-related macular degeneration and retinal injury [ 8 ]; however, there appears to be no prior reports having documented stabilization of this kind of myopic CNV after anti-VEGF failure using classical acupuncture. This case may represent the first such instance, suggesting that classic Chinese medicine acupuncture could play a supportive role in managing otherwise refractory retinal disease. The observed stabilization may be related to hemodynamic regulation and neurovascular self-adjustment. It is clear that this single-patient report cannot establish a generalized solution for all patients. The sustained anatomical and functional improvement experienced by this patient, after discontinuation of anti-VEGF therapy, suggests a potential adjunctive benefit of classic Chinese medicine acupuncture–one that merits further prospective and controlled investigation. Written informed consent was obtained from the patient for publication of this case report and accompanying images. All identifying information has been removed to protect this patient's privacy. The report adheres to the principles of the Declaration of Helsinki and conforms to the CARE Guidelines [ 10 ]. Conclusions A literature search was performed in PubMed, MEDLINE, and Google Scholar using the terms “pathologic myopia,” “choroidal neovascularization,” “acupuncture,” “classical Chinese medicine” with coverage from 2000 to 2025. No reports describing stabilization of myopic CNV after anti-VEGF failure with acupuncture were identified. References in related reviews were also screened. In this patient with pathologic myopia-related CNV refractory to anti-VEGF therapy, classic Chinese medicine acupuncture appears to have resolved her pathology. OCT and FA confirmed stabilization after 17 sessions of acupuncture, along with subjectively improved vision as reported by the patient. To our knowledge, this represents the first documented case of its kind, underscoring the potential role for classic Chinese medicine acupuncture as a supportive therapy in refractory retinal disease. It highlights the plausible need for systematic clinical evaluation and integrative ophthalmology. References Ohno-Matsui K, Ikuno Y, Lai TYY, Cheung CMG (2018) Diagnosis and treatment guideline for myopic choroidal neovascularization due to pathologic myopia. Progress in Retinal and Eye Research (Prog Retin Eye Res). 63:92–106. 10.1016/j.preteyeres.2017.10.005 Yoshida T, Ohno-Matsui K, Yasuzumi K et al (2003) Myopic choroidal neovascularization: a 10-year follow-up. Ophthalmology 110:1297–1305. 10.1016/S0161-6420(03)00461-5 Lim LS, Cheung CMG, Mitchell P, Wong TY (2011) Emerging evidence concerning systemic safety of anti-VEGF agents-Should ophthalmologists be concerned. Am J Ophthalmol 152:329–331. 10.1016/j.ajo.2011.05.040 Ng DS, Ho M, Iu LP, Lai TY (2022) Safety review of anti-VEGF therapy in patients with myopic choroidal neovascularization. Exp Opin Drug Saf 21:43–54. 10.1080/14740338.2021.1952979 Wang X, Fan Y, Lan H, Song Y, Shi Z, Zhang Z, Li X (2020) The efficacy and safety of acupuncture or combined with western medicine for dry eye: a protocol for systematic review and meta-analysis. Medicine 99:e20841. 10.1097/MD.0000000000021878 Lee MS, Shin BC, Ernst E (2011) Acupuncture for treating dry eye: A systematic review. Acta Ophthalmol 89:101–106. 10.1111/j.1755-3768.2009.01855.x Sun W, Zhao Y, Liao L, Wang X, Wei Q, Chao G, Zhou J (2023) Effects of acupuncture on age-related macular degeneration: A systematic review and meta-analysis of randomized controlled trials. PLoS ONE 18:e0283375. 10.1371/journal.pone.0283375 Xie TYX, Wei H (2022) Electroacupuncture improves choroidal blood flow to inhibit the development of lens-induced myopia in guinea pigs. Evidence-Based Complement Altern Med. 10.1155/2022/3286583 Che X (2025) Classic Chinese Medicine and Modern Challenges: A Timeless Path to Health. East-West Publishing Group, California Gagnier JJ, Kienle G, Altman DG et al (2013) The CARE guidelines: Consensus-based clinical case reporting guideline development. Global Adv Health Med 2:38–43. 10.7453/gahmj.2013.008 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8324294","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":558058901,"identity":"3ea1f753-b131-4296-ae13-ab96e0f4748b","order_by":0,"name":"Xia","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAkUlEQVRIiWNgGAWjYDACZiD+AGYlkKCFcQZpWkC6eEjSYnCc+eFn27bDDPzsOQbEaZFsZjOWzgVqkex5Q6QWfmYGM+bcttsMBjeItYWNmf0bsyVQiz3RWviZecyYGUG2SBDvF55iyZ5z/3kkzjwrIE6LwfnjGz/8KEuT429P3kCcFhjgIU35KBgFo2AUjAL8AADs0yO9jWiIBgAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0007-7564-255X","institution":"World I-Ching Health \u0026 Research Institute","correspondingAuthor":true,"prefix":"","firstName":"","middleName":"","lastName":"Xia","suffix":""}],"badges":[],"createdAt":"2025-12-10 07:28:03","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8324294/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8324294/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98422652,"identity":"859ba9d3-f0c3-4be7-81ab-a5ad42a212a8","added_by":"auto","created_at":"2025-12-17 16:31:17","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":25524,"visible":true,"origin":"","legend":"","description":"","filename":"StabalizationofMyopiaRelatedCNVUtilizingClassicChineseMedicineAcu.Cureus.docx","url":"https://assets-eu.researchsquare.com/files/rs-8324294/v1/19dd2513613f1246b747ea38.docx"},{"id":97949547,"identity":"4ddcbb22-c3fa-4443-9e44-44b73f7a7d52","added_by":"auto","created_at":"2025-12-11 06:39:40","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":342,"visible":true,"origin":"","legend":"","description":"","filename":"rs8324294.json","url":"https://assets-eu.researchsquare.com/files/rs-8324294/v1/b2c64e34278d5241e3271c9b.json"},{"id":98422821,"identity":"99121131-cfca-4239-b3e6-c7d972646ba7","added_by":"auto","created_at":"2025-12-17 16:31:32","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":30734,"visible":true,"origin":"","legend":"","description":"","filename":"rs83242940enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8324294/v1/4779d3c8bf1140f64dcafaa3.xml"},{"id":97949550,"identity":"0b0040e7-2d3d-48e8-bae0-74dda9b42074","added_by":"auto","created_at":"2025-12-11 06:39:40","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":29094,"visible":true,"origin":"","legend":"","description":"","filename":"rs83242940structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8324294/v1/3d8d0acb779df27a873f6ef1.xml"},{"id":98422220,"identity":"ce2b0e02-76f6-4619-adc5-86f8512203fa","added_by":"auto","created_at":"2025-12-17 16:30:40","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":33865,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8324294/v1/13e49d4d67905d39e871b09a.html"},{"id":98422199,"identity":"477bbb8a-2666-47a1-97ab-937660b8c2a9","added_by":"auto","created_at":"2025-12-17 16:30:38","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1130396,"visible":true,"origin":"","legend":"\u003cp\u003ePre-acupuncture (April 2025) - OCT showed worsening CNV despite four Avastin injections. Baseline (June 2025, after two sessions) - OCT demonstrated persistent CNV scarring and retinal irregularities; VA ≈ 20/200 OU.\u003c/p\u003e","description":"","filename":"IMAGING1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8324294/v1/c337ef7196fefcd0f3484b7e.jpg"},{"id":97949551,"identity":"4c884404-5ad7-415e-a896-8d3d6f1519f7","added_by":"auto","created_at":"2025-12-11 06:39:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1222210,"visible":true,"origin":"","legend":"\u003cp\u003eBaseline (June 2025, after two sessions) - OCT demonstrated persistent CNV scarring and retinal irregularities; VA ≈ 20/200 OU. After ~12 sessions (July 2025) - OCT showed improved retinal contour in the right eye (OD) and stability in the left (OS), with no subretinal fluid. The patient reported reduced central distortion.\u003c/p\u003e","description":"","filename":"IMAGING2.png","url":"https://assets-eu.researchsquare.com/files/rs-8324294/v1/ab6f2ab513a8aa5d6f114b4d.png"},{"id":97949552,"identity":"6f41fcab-4708-4c76-a799-0f73fd59f1c6","added_by":"auto","created_at":"2025-12-11 06:39:40","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":877298,"visible":true,"origin":"","legend":"\u003cp\u003eAfter ~12 sessions (July 2025) - OCT showed improved retinal contour in the right eye (OD) and stability in the left (OS), with no subretinal fluid. The patient reported reduced central distortion.\u003c/p\u003e","description":"","filename":"IMAGING3.png","url":"https://assets-eu.researchsquare.com/files/rs-8324294/v1/1d3c307fce2f712ed4e85f40.png"},{"id":98423480,"identity":"83c705bd-a6fd-4b35-8e42-f9a6eb7571fa","added_by":"auto","created_at":"2025-12-17 16:32:17","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":2940220,"visible":true,"origin":"","legend":"\u003cp\u003ePost treatment (September 2025, after 17 sessions, OD) - OCT and FA confirmed inactive CNV, no subretinal fluid, and stable retinal structure in the right eye. The patient reported improved vision, ocular comfort and relief of dry eye symptoms.\u003c/p\u003e","description":"","filename":"IMAGING4.png","url":"https://assets-eu.researchsquare.com/files/rs-8324294/v1/005ebc4ac529482cc409983e.png"},{"id":97949555,"identity":"5c7e856c-8b9e-473a-a381-75602245e1fd","added_by":"auto","created_at":"2025-12-11 06:39:41","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":2902736,"visible":true,"origin":"","legend":"\u003cp\u003ePost treatment (September 2025, after 17 sessions, OS) - OCT and FA showed inactive CNV and anatomical stability in the left eye, consistent with the patient’s subjective improvement and maintenance of visual function.\u003c/p\u003e","description":"","filename":"IMAGING5.png","url":"https://assets-eu.researchsquare.com/files/rs-8324294/v1/bababb62c99b444fa356f4a0.png"},{"id":98622119,"identity":"6015b113-0530-4388-836e-143103e57f40","added_by":"auto","created_at":"2025-12-19 16:45:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":11088560,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8324294/v1/28ee5258-ec72-4a10-a889-0cc1c5e7cb39.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eStabilization of Myopia–related Choroidal Neovascularization (CNV) with Classic Chinese Medicine Acupuncture after Anti-VEGF Failure: A Case Report\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePathologic myopia (PM) is a leading cause of irreversible visual impairment worldwide, and choroidal neovascularization (CNV) represents one of its most visually destructive complications [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The introduction of intravitreal anti-vascular endothelial growth factor (VEGF) agents-initially bevacizumab and ranibizumab, and more recently aflibercept (Eylea) and faricimab (Vabysmo)-has substantially improved visual outcomes in myopic CNV and remains the current standard of care [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, a subset of patients experience incomplete, transient, or suboptimal therapeutic responses despite appropriate treatment intervals. This highlights the ongoing need for adjunctive approaches that may enhance choroidal perfusion, reduce inflammatory signaling, or support retinal metabolic stability. Acupuncture has been explored as a complementary modality with the potential to influence ocular blood flow and neurovascular activity [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Additionally, recent reviews continue to underscore variability in long-term responsiveness to anti-VEGF therapy in myopic CNV, emphasizing gaps in sustained anatomical control for certain individuals [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Given these limitations, integrative approaches that support retinal microcirculation may offer clinical relevance. This case report describes a patient with PM-related CNV who achieved anatomical stabilization following a course of classic Chinese medicine acupuncture after limited therapeutic response to anti-VEGF therapy. The observed clinical improvements raise the possibility that classic Chinese medicine acupuncture may serve as an adjunctive option for selected cases with refractory or partially responsive myopic CNV.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 53-year-old female presented to an ophthalmology clinic in December 2024 with progressive blurred vision and central metamorphopsia. She was diagnosed with pathologic myopia complicated by CNV. Between December 2024 and April 2025, she received four intravitreal bevacizumab injections for recurrent CNV activity, but her condition showed no meaningful improvement. Her ophthalmic history extended back to 1999 and included previous retinal laser procedures, cataract surgery, and multiple bevacizumab injections in both eyes. Although her right eye had remained stable for several years, new CNV activity emerged in 2024, resulting in renewed visual decline. At presentation, her best-corrected visual acuity was approximately 20/200 in both eyes. Fundus examination and OCT revealed CNV-related scarring and retinal pigment epithelium changes, while fluorescein angiography indicated persistent neovascular activity. By June 2025, after reviewing serial imaging and clinical progression, her ophthalmologist determined that additional conventional treatment options were unlikely to be beneficial (Figs.\u0026nbsp;1\u0026ndash;2). In early June 2025, the patient initiated treatment with classic Chinese medicine acupuncture, guided by the Wu Yun Liu Qi theoretical framework. Over a 12-week period (June-August 2025), she completed 17 sessions, comprising approximately one and a half treatment courses. No electroacupuncture or other modern adjunctive modalities were used.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatient Perspective\u003c/h2\u003e\u003cp\u003eThe patient reported a long, challenging history of retinal disease: \u0026ldquo;I\u0026rsquo;ve had retinal problems since 1999, with laser surgery, cataract surgery, and Avastin shots in both eyes. The right eye had been stable for years until December 2024, when I developed new bleeding and central distortion.\u0026rdquo; As treatment progressed, she described improvements in functional vision: \u0026ldquo;The peripheral distortion in my left eye has improved more than the central vision, but I noticed improvement in the central area too. After my visit on Thursday (early September 2025), my vision was better than before the session. I could read the computer screen more easily, and it was a noticeable difference.\u0026rdquo; She further noted positive lifestyle changes undertaken with guidance from her acupuncture physician: \u0026ldquo;I also feel like changing the diet per your recommendations has improved my vision and helped my eyes heal.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eClinical Course With Imaging:\u003c/h3\u003e\n\u003cp\u003eOCT in April 2025 (pre-acupuncture) showed worsening CNV despite four bevacizumab injections (Fig.\u0026nbsp;1). By early June 2025, after two acupuncture sessions, imaging demonstrated persistent scarring and retinal irregularity, with visual acuity remaining approximately 20/200 in both eyes (Fig.\u0026nbsp;2). After approximately 12 sessions (June-July 2025), OCT revealed improved retinal contour in the right eye and stability in the left eye, with no evidence of subretinal fluid; subjectively, the patient reported decreased central distortion (Fig.\u0026nbsp;3). By early September 2025, after 17 sessions, OCT and fluorescein angiography confirmed inactive CNV, absence of subretinal fluid, and overall structural stability in both eyes (Figs.\u0026nbsp;4\u0026ndash;5). The patient reported improved visual clarity and vision, reduced ocular dryness and better overall comfort.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMyopic CNV arises from Bruch\u0026rsquo;s membrane breaks (lacquer cracks) and ischemia-induced stimulation of vascular endothelial growth factor (VEGF) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Anti-VEGF therapy effectively suppresses neovascular activity but typically requires repeated intravitreal injections. The introduction of newer agents, such as aflibercept (Eylea) and faricimab (Vabysmo), has improved treatment durability; however, a subset of patients remains unresponsive [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Acupuncture may enhance choroidal and retinal microcirculation through autonomic modulation, nitric oxide-mediated vasodilation, and neurotrophic signaling [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Additional evidence suggests that acupuncture may improve ocular function more broadly, including ocular-surface-related symptoms such as dry eye [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], supporting its potential role in ophthalmic care. Functional MRI studies have demonstrated increased occipital perfusion following ocular acupoint stimulation, while a recent OCT-A-based pilot study reported improved retinal vessel density in myopic CNV patients treated with acupuncture [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In the present case, despite four Avastin (bevacizumab) injections, the patient\u0026rsquo;s CNV continued to progress, consistent with the limited outcomes of anti-VEGF therapy in advanced pathologic myopia. After receiving classical Chinese medicine acupuncture, both OCT and fluorescein angiography (FA) findings demonstrated stabilization, suggesting a temporary association with the intervention. Possible mechanisms include improved ocular and choroidal circulation and neurovascular modulation. Although electroacupuncture has been shown to enhance choroidal blood flow in experimental myopia models [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], this case utilized a purely classical Chinese medicine acupuncture approach, guided by the Wu Yun Liu Qi (Five Movements and Six Qi) theory [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], underscoring the clinical relevance of traditional methodology. Previous studies have explored acupuncture for age-related macular degeneration and retinal injury [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]; however, there appears to be no prior reports having documented stabilization of this kind of myopic CNV after anti-VEGF failure using classical acupuncture. This case may represent the first such instance, suggesting that classic Chinese medicine acupuncture could play a supportive role in managing otherwise refractory retinal disease. The observed stabilization may be related to hemodynamic regulation and neurovascular self-adjustment. It is clear that this single-patient report cannot establish a generalized solution for all patients. The sustained anatomical and functional improvement experienced by this patient, after discontinuation of anti-VEGF therapy, suggests a potential adjunctive benefit of classic Chinese medicine acupuncture\u0026ndash;one that merits further prospective and controlled investigation.\u003c/p\u003e\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and accompanying images. All identifying information has been removed to protect this patient's privacy. The report adheres to the principles of the Declaration of Helsinki and conforms to the CARE Guidelines [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eA literature search was performed in PubMed, MEDLINE, and Google Scholar using the terms \u0026ldquo;pathologic myopia,\u0026rdquo; \u0026ldquo;choroidal neovascularization,\u0026rdquo; \u0026ldquo;acupuncture,\u0026rdquo; \u0026ldquo;classical Chinese medicine\u0026rdquo; with coverage from 2000 to 2025. No reports describing stabilization of myopic CNV after anti-VEGF failure with acupuncture were identified. References in related reviews were also screened. In this patient with pathologic myopia-related CNV refractory to anti-VEGF therapy, classic Chinese medicine acupuncture appears to have resolved her pathology. OCT and FA confirmed stabilization after 17 sessions of acupuncture, along with subjectively improved vision as reported by the patient. To our knowledge, this represents the first documented case of its kind, underscoring the potential role for classic Chinese medicine acupuncture as a supportive therapy in refractory retinal disease. It highlights the plausible need for systematic clinical evaluation and integrative ophthalmology.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOhno-Matsui K, Ikuno Y, Lai TYY, Cheung CMG (2018) Diagnosis and treatment guideline for myopic choroidal neovascularization due to pathologic myopia. 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Global Adv Health Med 2:38\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7453/gahmj.2013.008\u003c/span\u003e\u003cspan address=\"10.7453/gahmj.2013.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"World I-Ching Health \u0026 Research Institute","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"pathologic myopia, choroidal neovascularization, classical Chinese medicine, Wu Yun Liu Qi, acupuncture","lastPublishedDoi":"10.21203/rs.3.rs-8324294/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8324294/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePathologic myopia-related choroidal neovascularization (CNV) is a vision-threatening complication. Anti-vascular endothelial growth factor (VEGF) therapy is the current first-line treatment; however, some patients exhibit incomplete therapeutic response. This case report describes a middle-aged female with pathological myopia-related CNV who did not achieve stabilization after four intravitreal injections of bevacizumab (Avastin). Following an adjunctive course of classic Chinese medicine acupuncture consisting of 17 visits, optical coherence tomography (OCT) and fundus imaging demonstrated regression of exudation and stable visual acuity. This case highlights the potential role of classical Chinese medicine acupuncture in stabilizing myopic CNV when anti-VEGF therapy is insufficient and suggests a plausible integrative pathway for retinal microcirculation support.\u003c/p\u003e","manuscriptTitle":"Stabilization of Myopia–related Choroidal Neovascularization (CNV) with Classic Chinese Medicine Acupuncture after Anti-VEGF Failure: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-11 06:39:31","doi":"10.21203/rs.3.rs-8324294/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6875b377-373c-4dc8-9661-7d0e045ae171","owner":[],"postedDate":"December 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":59458314,"name":"Ophthalmology"}],"tags":[],"updatedAt":"2025-12-11T06:39:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-11 06:39:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8324294","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8324294","identity":"rs-8324294","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}