Clinical characteristics and curative effect of high myopia dome-shaped macula complicated with choroidal neovascularization_Chinese Journal of Ocular Fundus Diseases

Authors：

Yin Xiaofang , Ye Zuke , Wu Minhui , Tang Xiurong , Luo Shuke ,  Lu Yan

Department of Ophthalmology, The Second People's Hospital of Foshan, Foshan 528000, China;

Corresponding author：

Lu Yan, Email: 837800105@qq.com

Keywords：

Dome-shaped macula; High myopia; Choroidal neovascularization; Anti-vascular endothelial growth factor drug therapy

DOI：

10.3760/cma.j.cn511434-20240329-00128

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Objective To observe the clinical features of high myopia domed-shaped macula (DSM) complicated with choroidal neovascularization (CNV) and the efficacy of intravitreal injection of anti-vascular endothelial growth factor (VEGF). Methods A retrospective clinical study. A total of 23 eyes of 23 patients with high myopia DSM combined with CNV diagnosed by ophthalmology examination in Department of Ophthalmology of The Second People's Hospital of Foshan from January 2019 to December 2023 were included in the study.Best corrected visual acuity (BCVA), intraocular pressure, optical coherence tomography (OCT) were performed in all eyes. BCVA tests are performed using the international standard visual acuity chart, which was statistically converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. DSM height, central macular thickness (CMT) and choroidal thickness (ChT) were measured by OCT. According to OCT image features, DSM was divided into horizontal and vertical elliptic bulges and circular bulges. According to the literature standard, CNV was divided into subfoveal CNV and parafoveal CNV. All patients were treated with 0.05 ml intravitreal injection of ranibizumab or conbercept (IVR or IVC). The treatment regimen was 1+ on-demand treatment. The first IVR and IVC treatment were performed on 17 eyes and 6 eyes, respectively, and were divided into IVR group and IVC group. Follow-up time ≥1 month after treatment. The clinical features of the patients and the changes of BCVA, intraocular pressure, CMT and ChT after treatment were observed. Independent sample t test was used for comparison between groups. Results There were 23 eyes in 23 cases, 7 males had 7 eyes and 16 females had 16 eyes. There were 11 and 12 eyes in the right and left eyes respectively. Age were (49±16) years old; logMAR BCVA was 0.94±0.39. Shapes of DSM were in 13 (56.52%, 13/23), 6 (26.09%, 6/23), and 4 (17.39%, 4/23) eyes, respectively. The dome height was (97.83±46.14) μm. CMT and ChT were (276.39±98.35) and (49.48±31.66) μm, respectively. There were 17 eyes in the IVR group, including 4 males and 13 females. There were 6 cases in the IVC group, 3 cases were male and 3 cases were female. At the last follow-up, logMAR BCVA and CMT were 0.60±0.39 and (209.96±71.38) μm, respectively. BCVA was significantly increased and CMT was significantly decreased compared with before treatment, with statistical significance (t=2.98, 2.62; P=0.005, 0.010). One month after treatment and at the last follow-up, there were no significant differences in the degree of BCVA improvement (t=1.47, 1.35), intraocular pressure change (t=−0.20, −0.56) and ChT reduction thickness (t=0.80, −0.62) between IVR group and IVC group (P＞0.05). At 1 month after treatment and last follow-up, the CMT of patients in IVR group and IVC group was decreased by (57.94±67.61), (83.17±78.37) μm and (13.33±9.73), (18.17±17.88) μm compared with that before treatment, respectively, and the differences were statistically significant (t=2.64, 3.21; P＜0.05). Conclusions IVR or IVC in the treatment of high myopia DSM combined with CNV can effectively improve BCVA. The reduction of CMT with ranibizumab is better than conbercept.

Citation： Yin Xiaofang, Ye Zuke, Wu Minhui, Tang Xiurong, Luo Shuke, Lu Yan. Clinical characteristics and curative effect of high myopia dome-shaped macula complicated with choroidal neovascularization. Chinese Journal of Ocular Fundus Diseases, 2024, 40(9): 706-712. doi: 10.3760/cma.j.cn511434-20240329-00128 Copy

1.	Gaucher D, Erginay A, Lecleire-Collet A, et al. Dome-shaped macula in eyes with myopic posterior staphyloma[J]. Am J Ophthalmol, 2008, 145(5): 909-914. DOI: 10.1016/j.ajo.2008.01.012.
2.	Asakuma T, Yasuda M, Ninomiya T, et al. Prevalence and risk factors for myopic retinopathy in a Japanese population: the Hisayama study[J]. Ophthalmology, 2012, 119(9): 1760-1765. DOI: 10.1016/j.ophtha.2012.02.034.
3.	Tufail A, Narendran N, Patel PJ, et al. Ranibizumab in myopic choroidal neovascularization: the 12-month results from the REPAIR study[J]. Ophthalmology, 2013, 120(9): 1944-1945. DOI: 10.1016/j.ophtha.2013.06.010.
4.	Pozzo GF, Leone G, Mainetti C, et al. Response to treatment of choroidal neovascularization in highly myopic eyes with dome-shaped macula: two years of follow-up[J]. Retina, 2022, 42(6): 1057-1064. DOI: 10.1097/IAE.0000000000003431.
5.	Liang IC, Shimada N, Tanaka Y, et al. Comparison of clinical features in highly myopic eyes with and without a dome-shaped macula[J]. Ophthalmology, 2015, 122(8): 1591-1600. DOI: 10.1016/j.ophtha.2015.04.012.
6.	Caillaux V, Gaucher D, Gualino V, et al. Morphologic characterization of dome-shaped macula in myopic eyes with serous macular detachment[J]. Am J Ophthalmol, 2013, 156(5): 958-967. DOI: 10.1016/j.ajo.2013.06.032.
7.	Kumar V, Verma S, Azad SV, et al. Dome-shaped macula-review of literature[J]. Surv Ophthalmol, 2021, 66(4): 560-571. DOI: 10.1016/j.survophthal.2020.11.002.
8.	Errera MH, Michaelides M, Keane PA, et al. The extended clinical phenotype of dome-shaped macula[J]. Graefe's Arch Clin Exp Ophthalmol, 2014, 252(3): 499-508. DOI: 10.1007/s00417-013-2561-7.
9.	Ohsugi H, Ikuno Y, Oshima K, et al. Morphologic characteristics of macular complications of a dome-shaped macula determined by swept-source optical coherence tomography[J]. Am J Ophthalmol, 2014, 158(1): 162-170. DOI: 10.1016/j.ajo.2014.02.054.
10.	Zhu X, He W, Zhang S, et al. Dome-shaped macula: a potential protective factor for visual acuity after cataract surgery in patients with high myopia[J]. Br J Ophthalmol, 2019, 103(11): 1566-1570. DOI: 10.1136/bjophthalmol-2018-313279.
11.	Wong TY, Ferreira A, Hughes R, et al. Epidemiology and disease burden of pathologic myopia and myopic choroidal neovascularization: an evidence-based systematic review[J]. Am J Ophthalmol, 2014, 157(1): 9-25. DOI: 10.1016/j.ajo.2013.08.010.
12.	Hayashi K, Ohno-Matsui K, Shimada N, et al. Long-term pattern of progression of myopic maculopathy: a natural history study[J]. Ophthalmology, 2010, 117(8): 1595-1611. DOI: 10.1016/j.ophtha.2009.11.003.
13.	Hsu CC, Chen SJ, Li AF, et al. Systolic blood pressure, choroidal thickness, and axial length in patients with myopic maculopathy[J]. J Chin Med Assoc, 2014, 77(9): 487-491. DOI: 10.1016/j.jcma.2014.06.009.
14.	Kobayashi K, Mandai M, Suzuma I, et al. Expression of estrogen receptor in the choroidal neovascular membranes in highly myopic eyes[J]. Retina, 2002, 22(4): 418-422. DOI: 10.1097/00006982-200208000-00004.
15.	邵伊润, 毛剑波, 沈丽君, 等. 高度近视继发脉络膜新生血管和单纯高度近视患眼以及正常眼黄斑区血流参数对比观察[J]. 中华眼底病杂志, 2019, 35(5): 446-450. DOI: 10.3760/cma.j.issn.1005-1015.2019.05.005.Shao YR, Mao JB, Shen LJ, et al. The comparison of macular blood flow parameters in myopic choroidal neovascularization, high myopia and normal people[J]. Chin J Ocul Fundus Dis, 2019, 35(5): 446-450. DOI: 10.3760/cma.j.issn.1005-1015.2019.05.005.
16.	Wakabayashi T, Ikuno Y. Choroidal filling delay in choroidal neovascularisation due to pathological myopia[J]. Br J Ophthalmol, 2010, 94(5): 611-615. DOI: 10.1136/bjo.2009.163535.
17.	Wolf S, Balciuniene VJ, Laganovska G, et al. A randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia[J]. Ophthalmology, 2014, 121(3): 682-692. DOI: 10.1016/j.ophtha.2013.10.023.
18.	Zhu Y, Zhang T, Xu G, et al. Anti-vascular endothelial growth factor for choroidal neovascularisation in people with pathological myopia[J/OL]. Cochrane Database Syst Rev, 2016, 12(12): CD11160[2016-12-15]. https://pubmed.ncbi.nlm.nih.gov/27977064/. DOI: 10.1002/14651858.CD011160.pub2.
19.	张彩云, 黎楚岚, 毛剑波, 等. 玻璃体腔注射康柏西普与雷珠单抗治疗高度近视继发脉络膜新生血管[J]. 国际眼科杂志, 2022, 22(6): 1006-1009. DOI: 10.3980/j.issn.1672-5123.2022.6.24.Zhang CY, Li CR, Mao JB, et al. Intravitreal conbercept or ranibizumab for myopic choroidal neovascularization[J]. Int Eye Sci, 2022, 22(6): 1006-1009. DOI: 10.3980/j.issn.1672-5123.2022.6.24.
20.	Marchese A, Arrigo A, Sacconi R, et al. Spectrum of choroidal neovascularisation associated with dome-shaped macula[J]. Br J Ophthalmol, 2019, 103(8): 1146-1151. DOI: 10.1136/bjophthalmol-2018-312780.
21.	Ellabban AA, Tsujikawa A, Matsumoto A, et al. Three-dimensional tomographic features of dome-shaped macula by swept-source optical coherence tomography[J]. Am J Ophthalmol, 2013, 155(2): 320-328. DOI: 10.1016/j.ajo.2012.08.007.
22.	Viola F, Dell'Arti L, Benatti E, et al. Choroidal findings in dome-shaped macula in highly myopic eyes: a longitudinal study[J]. Am J Ophthalmol, 2015, 159(1): 44-52. DOI: 10.1016/j.ajo.2014.09.026.
23.	Ellabban AA, Tsujikawa A, Muraoka Y, et al. Dome-shaped macular configuration: longitudinal changes in the sclera and choroid by swept-source optical coherence tomography over two years[J]. Am J Ophthalmol, 2014, 158(5): 1062-1070. DOI: 10.1016/j.ajo.2014.08.006.
24.	Wang L, Lin BW, Yin XF, et al. Visual acuity and size of choroidal neovascularization in highly myopic eyes with a dome-shaped macula[J/OL]. J Ophthalmol, 2020, 2020: 8852156[2020-11-23]. https://pubmed.ncbi.nlm.nih.gov/33489346/. DOI: 10.1155/2020/8852156.

1. Gaucher D, Erginay A, Lecleire-Collet A, et al. Dome-shaped macula in eyes with myopic posterior staphyloma[J]. Am J Ophthalmol, 2008, 145(5): 909-914. DOI: 10.1016/j.ajo.2008.01.012.
2. Asakuma T, Yasuda M, Ninomiya T, et al. Prevalence and risk factors for myopic retinopathy in a Japanese population: the Hisayama study[J]. Ophthalmology, 2012, 119(9): 1760-1765. DOI: 10.1016/j.ophtha.2012.02.034.
3. Tufail A, Narendran N, Patel PJ, et al. Ranibizumab in myopic choroidal neovascularization: the 12-month results from the REPAIR study[J]. Ophthalmology, 2013, 120(9): 1944-1945. DOI: 10.1016/j.ophtha.2013.06.010.
4. Pozzo GF, Leone G, Mainetti C, et al. Response to treatment of choroidal neovascularization in highly myopic eyes with dome-shaped macula: two years of follow-up[J]. Retina, 2022, 42(6): 1057-1064. DOI: 10.1097/IAE.0000000000003431.
5. Liang IC, Shimada N, Tanaka Y, et al. Comparison of clinical features in highly myopic eyes with and without a dome-shaped macula[J]. Ophthalmology, 2015, 122(8): 1591-1600. DOI: 10.1016/j.ophtha.2015.04.012.
6. Caillaux V, Gaucher D, Gualino V, et al. Morphologic characterization of dome-shaped macula in myopic eyes with serous macular detachment[J]. Am J Ophthalmol, 2013, 156(5): 958-967. DOI: 10.1016/j.ajo.2013.06.032.
7. Kumar V, Verma S, Azad SV, et al. Dome-shaped macula-review of literature[J]. Surv Ophthalmol, 2021, 66(4): 560-571. DOI: 10.1016/j.survophthal.2020.11.002.
8. Errera MH, Michaelides M, Keane PA, et al. The extended clinical phenotype of dome-shaped macula[J]. Graefe's Arch Clin Exp Ophthalmol, 2014, 252(3): 499-508. DOI: 10.1007/s00417-013-2561-7.
9. Ohsugi H, Ikuno Y, Oshima K, et al. Morphologic characteristics of macular complications of a dome-shaped macula determined by swept-source optical coherence tomography[J]. Am J Ophthalmol, 2014, 158(1): 162-170. DOI: 10.1016/j.ajo.2014.02.054.
10. Zhu X, He W, Zhang S, et al. Dome-shaped macula: a potential protective factor for visual acuity after cataract surgery in patients with high myopia[J]. Br J Ophthalmol, 2019, 103(11): 1566-1570. DOI: 10.1136/bjophthalmol-2018-313279.
11. Wong TY, Ferreira A, Hughes R, et al. Epidemiology and disease burden of pathologic myopia and myopic choroidal neovascularization: an evidence-based systematic review[J]. Am J Ophthalmol, 2014, 157(1): 9-25. DOI: 10.1016/j.ajo.2013.08.010.
12. Hayashi K, Ohno-Matsui K, Shimada N, et al. Long-term pattern of progression of myopic maculopathy: a natural history study[J]. Ophthalmology, 2010, 117(8): 1595-1611. DOI: 10.1016/j.ophtha.2009.11.003.
13. Hsu CC, Chen SJ, Li AF, et al. Systolic blood pressure, choroidal thickness, and axial length in patients with myopic maculopathy[J]. J Chin Med Assoc, 2014, 77(9): 487-491. DOI: 10.1016/j.jcma.2014.06.009.
14. Kobayashi K, Mandai M, Suzuma I, et al. Expression of estrogen receptor in the choroidal neovascular membranes in highly myopic eyes[J]. Retina, 2002, 22(4): 418-422. DOI: 10.1097/00006982-200208000-00004.
15. 邵伊润, 毛剑波, 沈丽君, 等. 高度近视继发脉络膜新生血管和单纯高度近视患眼以及正常眼黄斑区血流参数对比观察[J]. 中华眼底病杂志, 2019, 35(5): 446-450. DOI: 10.3760/cma.j.issn.1005-1015.2019.05.005.Shao YR, Mao JB, Shen LJ, et al. The comparison of macular blood flow parameters in myopic choroidal neovascularization, high myopia and normal people[J]. Chin J Ocul Fundus Dis, 2019, 35(5): 446-450. DOI: 10.3760/cma.j.issn.1005-1015.2019.05.005.
16. Wakabayashi T, Ikuno Y. Choroidal filling delay in choroidal neovascularisation due to pathological myopia[J]. Br J Ophthalmol, 2010, 94(5): 611-615. DOI: 10.1136/bjo.2009.163535.
17. Wolf S, Balciuniene VJ, Laganovska G, et al. A randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia[J]. Ophthalmology, 2014, 121(3): 682-692. DOI: 10.1016/j.ophtha.2013.10.023.
18. Zhu Y, Zhang T, Xu G, et al. Anti-vascular endothelial growth factor for choroidal neovascularisation in people with pathological myopia[J/OL]. Cochrane Database Syst Rev, 2016, 12(12): CD11160[2016-12-15]. https://pubmed.ncbi.nlm.nih.gov/27977064/. DOI: 10.1002/14651858.CD011160.pub2.
19. 张彩云, 黎楚岚, 毛剑波, 等. 玻璃体腔注射康柏西普与雷珠单抗治疗高度近视继发脉络膜新生血管[J]. 国际眼科杂志, 2022, 22(6): 1006-1009. DOI: 10.3980/j.issn.1672-5123.2022.6.24.Zhang CY, Li CR, Mao JB, et al. Intravitreal conbercept or ranibizumab for myopic choroidal neovascularization[J]. Int Eye Sci, 2022, 22(6): 1006-1009. DOI: 10.3980/j.issn.1672-5123.2022.6.24.
20. Marchese A, Arrigo A, Sacconi R, et al. Spectrum of choroidal neovascularisation associated with dome-shaped macula[J]. Br J Ophthalmol, 2019, 103(8): 1146-1151. DOI: 10.1136/bjophthalmol-2018-312780.
21. Ellabban AA, Tsujikawa A, Matsumoto A, et al. Three-dimensional tomographic features of dome-shaped macula by swept-source optical coherence tomography[J]. Am J Ophthalmol, 2013, 155(2): 320-328. DOI: 10.1016/j.ajo.2012.08.007.
22. Viola F, Dell'Arti L, Benatti E, et al. Choroidal findings in dome-shaped macula in highly myopic eyes: a longitudinal study[J]. Am J Ophthalmol, 2015, 159(1): 44-52. DOI: 10.1016/j.ajo.2014.09.026.
23. Ellabban AA, Tsujikawa A, Muraoka Y, et al. Dome-shaped macular configuration: longitudinal changes in the sclera and choroid by swept-source optical coherence tomography over two years[J]. Am J Ophthalmol, 2014, 158(5): 1062-1070. DOI: 10.1016/j.ajo.2014.08.006.
24. Wang L, Lin BW, Yin XF, et al. Visual acuity and size of choroidal neovascularization in highly myopic eyes with a dome-shaped macula[J/OL]. J Ophthalmol, 2020, 2020: 8852156[2020-11-23]. https://pubmed.ncbi.nlm.nih.gov/33489346/. DOI: 10.1155/2020/8852156.

Chinese Journal of Ocular Fundus Diseases

Clinical characteristics and curative effect of high myopia dome-shaped macula complicated with choroidal neovascularization

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