Aim To determine whether there is a correlation between the presence of macular dilated choroidal vein (DCV) and the recurrence of myopic macular neovascularisation (MNV) after antivascular endothelial growth factor (VEGF) treatment. Methods Medical records of 168 eyes of 163 patients with myopic MNV were reviewed for the presence of macular DCV and episodes of recurrences. A macular DCV was defined as a choroidal vein whose diameter was 2x larger than the adjacent veins coursing in the macular area of 5.5 mm diameter. Results Macular DCV existed in 47 (28%) of the eyes with myopic MNV. 70 eyes (41.7%) had recurrence during a mean follow-up period of 52.5 +/- 23.0 months. Recurrence was found in 28 of the 47 eyes (59.6%) with DCV, which was significantly more frequent than the 42 of the 121 eyes (34.7%) without DCV (p=0.003). Cox model analysis showed that macular DCV was an independent risk factor (HR: 2.0, 95% CI 1.1 to 3.5) for recurrence. The recurrence rate was significantly higher in eyes with DCV within the first 2 years after the onset than in eyes without DCV. Conclusions Macular DCVs may be indicators of a more aggressive phenotype of eyes with myopic MNV. These eyes need careful monitoring after anti-VEGF therapies.