Choroidal neovascularization secondary to pathologic myopia:a recent update on diagnosis and treatment_Chinese Journal of Ocular Fundus Diseases

Authors：

ZhanZongyi , LiZijing ,  DingXiaoyan

Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China;

Corresponding author：

DingXiaoyan, Email: Dingxy75@gmail.com

Keywords：

Choroidal neovascularization/diagnosis; Choroidal neovascularization/therapy; Myopia, degenerative/complications; Review

DOI：

10.3760/cma.j.issn.1005-1015.2016.01.029

Video：

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Abstract Full text Figures/Tables Video References Cited by

Pathological myopia can induce choroidal neovascularization (PM-CNV). The potential risk factors include ageing, long axial length of the eyeball, thinning of subfoveal choroidal thickness, fundus atrophy spot and lacquer crack. These factors may induce atrophy of retinal pigment epithelial cells (RPE) and hypoxia, resulting in vascular endothelial growth factors (VEGF) secretion by outer retina. The lesion type, location and activity of PM-CNV can be determined by fundus fluorescein angiography. The features of PM-CNV on optical coherence tomography include strong reflective area close to RPE with very small amount of subretinal fluid (active stage), surface strong reflection with signal attenuation area (scar stage) and flat lesion and chorioretinal atrophy (atrophy stage). Photodynamic therapy and intravitreal injection of anti-VEGF drugs are major treatments for PM-CNV, the latter is more commonly used now. However, more large randomized controlled studies are required to explore the treatment regimen (such as frequency, indications for repeated or termination of treatment) and the efficacy factors further.

Citation： ZhanZongyi, LiZijing, DingXiaoyan. Choroidal neovascularization secondary to pathologic myopia:a recent update on diagnosis and treatment. Chinese Journal of Ocular Fundus Diseases, 2016, 32(1): 104-107. doi: 10.3760/cma.j.issn.1005-1015.2016.01.029 Copy

1.	Wong TY, Foster PJ, Hee J, et al. Prevalence and risk factors for refractive errors in adult Chinese in Singapore[J]. Invest Ophthalmol Vis Sci,2000,41(9):2486-2494.
2.	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.
3.	Yoshida T,Ohno-Matsui K,Yasuzumi K, et al. Myopic choroidal neovascularization: a 10-year follow-up[J]. Ophthalmology, 2003, 110(7): 1297-1305. DOI: 10.1016/S0161-6420(03)00461-5.
4.	Ohno-Matsui K, Yoshida T, Futagami S, et al. Patchy atrophy and lacquer cracks predispose to the development of choroidal neovascularisation in pathological myopia[J].Br J Ophthalmol, 2003,87(5):570-573. DOI: 10.1136/bjo.87.5.570.
5.	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.
6.	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.
7.	Shiose S, Hata Y, Noda Y, et al. Fibrinogen stimulates in vitro angiogenesis by choroidal endothelial cells via autocrine VEGF[J].Graefe's Arch Clin Exp Ophthalmol, 2004, 242(9): 777-783. DOI: 10.1007/s00417-004-0910-2.
8.	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.
9.	Shih Y, Ho T, Hsiao C, et al.Visual outcomes for high myopic pat ients with or without myopic maculopathy: a 10 year follow up study[J]. Br J Ophthalmol,2006,90(5): 546-550.
10.	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.
11.	Ikuno Y, Jo Y, Hamasaki T, et al. Ocular risk factors for choroidal neovascularization in pathologic myopia[J]. Invest Ophthalmol Vis Sci,2010, 51(7): 3721-3725. DOI:10.1167/iovs.09-3493.
12.	Soubrane G.Choroidal neovascularization in pathologic myopia: recent developments in diagnosis and treatment[J]. Surv Ophthalmol, 2008, 53(2):121-138. DOI: 10.1016/j.survophthal.2007.12.004.
13.	Axer-Siegel R, Cotlear D, Priel E, et al. Indocyanine green angiography in high myopia[J]. Ophthalmic Surg Lasers Imaging, 2004,35(2): 139-145.
14.	Baba T, Ohno-Matsui K, Yoshida T, et al. Optical coherence tomography of choroidal neo vascularization in high myopia[J]. Acta Ophthalmol Scand, 2002,80(1): 82-87.
15.	Moschos MN, Panayotidis D, Moschos MM, et al. A preliminary assessment of macular function by mf-ERG in myopic eyes with CNV with complete response to photodynamic therapy[J]. Eur J Ophthalmol, 2003,13(5):461-467.
16.	Rohrschneider K,Bultmann S,Springer C. Use of fundus peimetry (microperimeery) to quantify macular sensitivity[J]. Prog Retin Eye Res, 2008, 27(5):536-548. DOI: 10.1016/j.preteyeres.2008.07.003.
17.	徐吉,魏璐,俞素勤,等.病理性近视患者黄斑功能的微视野检查[J].中华眼底病杂志,2011,27(1):52-55. DOI:10.3760/cma.j.issn.1005-1015.2011.01.012.Xu J, Wei L, Yu SQ, et al. Macular function of pathologic myopic retina evaluated by microperimetry[J].Chin J Ocul Fundus Dis, 2011,27(1):52-55. DOI:10.3760/cma.j.issn.1005-1015.2011.01.012.
18.	Montero JA, Ruiz-Moreno JM. Verteporfin photodynamic therapy in highly myopic subfoveal choroidal neovascularisation[J]. Br J Ophthalmol, 2003, 87(2): 173-176. DOI: 10.1136/bjo.87.2.173.
19.	Verteporfin in Photodynamic Therapy (VIP) Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in pathologic myopia with verteporfin, 1-year results of a randomized clinical trial——VIP report No 1[J]. Ophthalmology, 2001,108(5): 841-852.
20.	Verteporfin in Photodynamic Therapy (VIP) Study Group. Verteporfin therapy of subfoveal choroidal neovascularization in pathologic myopia: 2-year results of a randomized clinical trial--VIP report No 3[J]. Ophthalmology, 2003, 110(4): 667-673.
21.	Hayashi K, Ohno-Matsui K, Shimada N, et al. Long-term results of photodynamic therapy for choroidal neovascularizaion in Japanese patients with pathologic myopia[J]. Am J Ophthalmol, 2011,151(1): 137-147. DOI: 10.1016/j.ajo.2010.06.046.
22.	Coutinho AM, Silva RM, Nunes SG, et al. Photodynamic therapy in highly myopic eyes with choroidal neovascularization: 5 years of follow-up[J]. Retina,2011,31(6):1089-1094. DOI:10.1097/IAE.0b013e3181ff9546.
23.	Lam DS, Chan WM, Liu DT, et al.Photodynamic therapy with verteporfin for subfoveal choroidal neovascularisation of pathologic myopia in Chinese eyes: a prospective series of 1-and 2-year follow-up[J]. Br J Ophthalmol, 2004,88(10): 1315-1319. DOI: 10.1136/bjo.2004.041624.
24.	Hayashi K, Ohno-Matsui K, Teramukai S, et al. Photodynamic therapy with verteporfin for choroidal neovascularization of pathologic myopia in Japenese atients: comparison with nontreated controls[J]. Am J Ophthalmol, 2008, 145(3):518-526.DOI: 10.1016/j.ajo.2007.10.032.
25.	Hussain N, Khanna R, Das T. Two year follow-up outcome of vertepro?n therapy for subfoveal choroidal neovascualrization in pathologic myopia in Indian eyes[J]. Indian J Ophthalmol, 2008,56(6):465-468.
26.	Neelam K, Cheung CM, Ohno-Matsui K, et al. Choroidal neovascularization in pathological myopia[J]. Prog Retin Eye Res,2012,31(5):495-525. DOI: 10.1016/j.preteyeres.2012.04.001.
27.	Leung DW, Cachianes G, Kuang WJ, et al. Vascular endothelial growth factor is a secreted angiogenic mitogen[J]. Science, 1989, 246(4935):1306-1309.
28.	Nguyen QD, Shah S, Tatlipinar S, et al. Bevacizumab suppresses choroidal neovascularisation caused by pathological myopia[J]. Br J Ophthalmol,2005,89(10):1368-1370. DOI: 10.1136/bjo.2005.066431.
29.	Yang X, Dai H. Intravitreal ranibizumab for the treatment of pathological myopia associated with choroidal neovascularization in Chinese patients[J]. Chin Med J (Engl), 2014, 127(16):2906-2910. DOI:10.3760/cma.j.issn.0366-6999.20132990.
30.	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.
31.	Wolf S, Balciuniene VJ, Laganovska G, et al. RADIANCE: 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.
32.	Peiretti E, Vinci M, Fossarello M. Intravitreal bevacizumab as a treatment for choroidal neovascularisation secondary to myopia: 4-year study results[J]. Can J Ophthalmol, 2012,47(1):28-33.DOI: 10.1016/j.jcjo.2011.12.009.
33.	Yang HS, Kim JG, Kim JT, et al. Prognostic factors of eyes with naïve subfoveal myopic choroidal neovascularization after intravitreal bevacizumab[J]. Am J Ophthalmol, 2013,156(6):1201-1210. DOI:10.1016/j.ajo.2013.08.002.
34.	Lai TY, Luk FO, Lee GK, et al. Long-term outcome of intravitreal anti-vascular endothelial growth factor therapy with bevacizumab or ranibizumab as primary treatment for subfoveal myopic choroidal neovascularization[J]. Eye (Lond), 2012,26(7):1004-1011. DOI: 10.1038/eye.2012.97.
35.	Miyake M, Yamashiro K, Akagi-Kurashige Y, et al. Vascular endothelial growth factor gene and the response to anti-vascular endothelial growth factor treatment for choroidal neovascularization in high myopia[J]. Ophthalmology, 2014,121(1):225-233. DOI: 10.1016/j.ophtha.2013.06.043.
36.	Wang E, Chen Y. Intravitreal anti-vascular endothelial growth factor for choroidal neovascularization secondary to pathologic myopia: systematic review and meta-analysis[J]. Retina, 2013,33(7):1375-1392. DOI: 10.1097/IAE.0b013e31827d260a.
37.	Shimada N, Ohno-Matsui K, Hayashi K, et al. Macular detachment after successful intravitreal bevacizumab for myopic choroidal neovascularization[J]. Jpn J Ophthalmol, 2011,55(4):378-382. DOI: 10.1007/s10384-011-0034-2.
38.	Degenring RF, Jonas JB. Photodynamic therapy in combination with intravitreal triamcinolone for myopic choroidal neovascularization[J]. Acta Ophthalmol Scand, 2005,83(5):621. DOI: 10.1111/j.1600-0420.2005.00506.x.
39.	Chan WM, Lai TY, Wong AL, et al. Combined photodynamic therapy and intravitreal triamcinolone injection for the treatment of choroidal neovascularization secondary to pathological myopia: a pilot study[J]. Br J Ophthalmol, 2007,91(2):174-179.
40.	Saviano S, Piermarocchi R, Leon PE, et al. Combined therapy with bevacizumab and photodynamic therapy for myopic choroidal neovascularization: a one-year follow-up controlled study[J]. Int J Ophthalmol, 2014,7(2):335-339.DOI: 10.3980/j.issn.2222-3959.2014.02.26.
41.	Ikuno Y, Ohno-Matsui K, Wong TY, et al. Intravitreal aflibercept injection in patients with myopic choroidal neovascularization: the MYRROR study[J]. Ophthalmology, 2015, 122(6):1220-1227. DOI:10.1016/j.ophtha.2015.01.025.
42.	Sasore T, Kennedy B. Deciphering combinations of PI3K/AKT/mTOR pathway drugs augmenting anti-angiogenic efficacy in vivo. PLoS One, 2014, 9(8):105280. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0105280. DOI: 10.1371/journal.pone.0105280.

1. Wong TY, Foster PJ, Hee J, et al. Prevalence and risk factors for refractive errors in adult Chinese in Singapore[J]. Invest Ophthalmol Vis Sci,2000,41(9):2486-2494.
2. 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.
3. Yoshida T,Ohno-Matsui K,Yasuzumi K, et al. Myopic choroidal neovascularization: a 10-year follow-up[J]. Ophthalmology, 2003, 110(7): 1297-1305. DOI: 10.1016/S0161-6420(03)00461-5.
4. Ohno-Matsui K, Yoshida T, Futagami S, et al. Patchy atrophy and lacquer cracks predispose to the development of choroidal neovascularisation in pathological myopia[J].Br J Ophthalmol, 2003,87(5):570-573. DOI: 10.1136/bjo.87.5.570.
5. 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.
6. 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.
7. Shiose S, Hata Y, Noda Y, et al. Fibrinogen stimulates in vitro angiogenesis by choroidal endothelial cells via autocrine VEGF[J].Graefe's Arch Clin Exp Ophthalmol, 2004, 242(9): 777-783. DOI: 10.1007/s00417-004-0910-2.
8. 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.
9. Shih Y, Ho T, Hsiao C, et al.Visual outcomes for high myopic pat ients with or without myopic maculopathy: a 10 year follow up study[J]. Br J Ophthalmol,2006,90(5): 546-550.
10. 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.
11. Ikuno Y, Jo Y, Hamasaki T, et al. Ocular risk factors for choroidal neovascularization in pathologic myopia[J]. Invest Ophthalmol Vis Sci,2010, 51(7): 3721-3725. DOI:10.1167/iovs.09-3493.
12. Soubrane G.Choroidal neovascularization in pathologic myopia: recent developments in diagnosis and treatment[J]. Surv Ophthalmol, 2008, 53(2):121-138. DOI: 10.1016/j.survophthal.2007.12.004.
13. Axer-Siegel R, Cotlear D, Priel E, et al. Indocyanine green angiography in high myopia[J]. Ophthalmic Surg Lasers Imaging, 2004,35(2): 139-145.
14. Baba T, Ohno-Matsui K, Yoshida T, et al. Optical coherence tomography of choroidal neo vascularization in high myopia[J]. Acta Ophthalmol Scand, 2002,80(1): 82-87.
15. Moschos MN, Panayotidis D, Moschos MM, et al. A preliminary assessment of macular function by mf-ERG in myopic eyes with CNV with complete response to photodynamic therapy[J]. Eur J Ophthalmol, 2003,13(5):461-467.
16. Rohrschneider K,Bultmann S,Springer C. Use of fundus peimetry (microperimeery) to quantify macular sensitivity[J]. Prog Retin Eye Res, 2008, 27(5):536-548. DOI: 10.1016/j.preteyeres.2008.07.003.
17. 徐吉,魏璐,俞素勤,等.病理性近视患者黄斑功能的微视野检查[J].中华眼底病杂志,2011,27(1):52-55. DOI:10.3760/cma.j.issn.1005-1015.2011.01.012.Xu J, Wei L, Yu SQ, et al. Macular function of pathologic myopic retina evaluated by microperimetry[J].Chin J Ocul Fundus Dis, 2011,27(1):52-55. DOI:10.3760/cma.j.issn.1005-1015.2011.01.012.
18. Montero JA, Ruiz-Moreno JM. Verteporfin photodynamic therapy in highly myopic subfoveal choroidal neovascularisation[J]. Br J Ophthalmol, 2003, 87(2): 173-176. DOI: 10.1136/bjo.87.2.173.
19. Verteporfin in Photodynamic Therapy (VIP) Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in pathologic myopia with verteporfin, 1-year results of a randomized clinical trial——VIP report No 1[J]. Ophthalmology, 2001,108(5): 841-852.
20. Verteporfin in Photodynamic Therapy (VIP) Study Group. Verteporfin therapy of subfoveal choroidal neovascularization in pathologic myopia: 2-year results of a randomized clinical trial--VIP report No 3[J]. Ophthalmology, 2003, 110(4): 667-673.
21. Hayashi K, Ohno-Matsui K, Shimada N, et al. Long-term results of photodynamic therapy for choroidal neovascularizaion in Japanese patients with pathologic myopia[J]. Am J Ophthalmol, 2011,151(1): 137-147. DOI: 10.1016/j.ajo.2010.06.046.
22. Coutinho AM, Silva RM, Nunes SG, et al. Photodynamic therapy in highly myopic eyes with choroidal neovascularization: 5 years of follow-up[J]. Retina,2011,31(6):1089-1094. DOI:10.1097/IAE.0b013e3181ff9546.
23. Lam DS, Chan WM, Liu DT, et al.Photodynamic therapy with verteporfin for subfoveal choroidal neovascularisation of pathologic myopia in Chinese eyes: a prospective series of 1-and 2-year follow-up[J]. Br J Ophthalmol, 2004,88(10): 1315-1319. DOI: 10.1136/bjo.2004.041624.
24. Hayashi K, Ohno-Matsui K, Teramukai S, et al. Photodynamic therapy with verteporfin for choroidal neovascularization of pathologic myopia in Japenese atients: comparison with nontreated controls[J]. Am J Ophthalmol, 2008, 145(3):518-526.DOI: 10.1016/j.ajo.2007.10.032.
25. Hussain N, Khanna R, Das T. Two year follow-up outcome of vertepro?n therapy for subfoveal choroidal neovascualrization in pathologic myopia in Indian eyes[J]. Indian J Ophthalmol, 2008,56(6):465-468.
26. Neelam K, Cheung CM, Ohno-Matsui K, et al. Choroidal neovascularization in pathological myopia[J]. Prog Retin Eye Res,2012,31(5):495-525. DOI: 10.1016/j.preteyeres.2012.04.001.
27. Leung DW, Cachianes G, Kuang WJ, et al. Vascular endothelial growth factor is a secreted angiogenic mitogen[J]. Science, 1989, 246(4935):1306-1309.
28. Nguyen QD, Shah S, Tatlipinar S, et al. Bevacizumab suppresses choroidal neovascularisation caused by pathological myopia[J]. Br J Ophthalmol,2005,89(10):1368-1370. DOI: 10.1136/bjo.2005.066431.
29. Yang X, Dai H. Intravitreal ranibizumab for the treatment of pathological myopia associated with choroidal neovascularization in Chinese patients[J]. Chin Med J (Engl), 2014, 127(16):2906-2910. DOI:10.3760/cma.j.issn.0366-6999.20132990.
30. 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.
31. Wolf S, Balciuniene VJ, Laganovska G, et al. RADIANCE: 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.
32. Peiretti E, Vinci M, Fossarello M. Intravitreal bevacizumab as a treatment for choroidal neovascularisation secondary to myopia: 4-year study results[J]. Can J Ophthalmol, 2012,47(1):28-33.DOI: 10.1016/j.jcjo.2011.12.009.
33. Yang HS, Kim JG, Kim JT, et al. Prognostic factors of eyes with naïve subfoveal myopic choroidal neovascularization after intravitreal bevacizumab[J]. Am J Ophthalmol, 2013,156(6):1201-1210. DOI:10.1016/j.ajo.2013.08.002.
34. Lai TY, Luk FO, Lee GK, et al. Long-term outcome of intravitreal anti-vascular endothelial growth factor therapy with bevacizumab or ranibizumab as primary treatment for subfoveal myopic choroidal neovascularization[J]. Eye (Lond), 2012,26(7):1004-1011. DOI: 10.1038/eye.2012.97.
35. Miyake M, Yamashiro K, Akagi-Kurashige Y, et al. Vascular endothelial growth factor gene and the response to anti-vascular endothelial growth factor treatment for choroidal neovascularization in high myopia[J]. Ophthalmology, 2014,121(1):225-233. DOI: 10.1016/j.ophtha.2013.06.043.
36. Wang E, Chen Y. Intravitreal anti-vascular endothelial growth factor for choroidal neovascularization secondary to pathologic myopia: systematic review and meta-analysis[J]. Retina, 2013,33(7):1375-1392. DOI: 10.1097/IAE.0b013e31827d260a.
37. Shimada N, Ohno-Matsui K, Hayashi K, et al. Macular detachment after successful intravitreal bevacizumab for myopic choroidal neovascularization[J]. Jpn J Ophthalmol, 2011,55(4):378-382. DOI: 10.1007/s10384-011-0034-2.
38. Degenring RF, Jonas JB. Photodynamic therapy in combination with intravitreal triamcinolone for myopic choroidal neovascularization[J]. Acta Ophthalmol Scand, 2005,83(5):621. DOI: 10.1111/j.1600-0420.2005.00506.x.
39. Chan WM, Lai TY, Wong AL, et al. Combined photodynamic therapy and intravitreal triamcinolone injection for the treatment of choroidal neovascularization secondary to pathological myopia: a pilot study[J]. Br J Ophthalmol, 2007,91(2):174-179.
40. Saviano S, Piermarocchi R, Leon PE, et al. Combined therapy with bevacizumab and photodynamic therapy for myopic choroidal neovascularization: a one-year follow-up controlled study[J]. Int J Ophthalmol, 2014,7(2):335-339.DOI: 10.3980/j.issn.2222-3959.2014.02.26.
41. Ikuno Y, Ohno-Matsui K, Wong TY, et al. Intravitreal aflibercept injection in patients with myopic choroidal neovascularization: the MYRROR study[J]. Ophthalmology, 2015, 122(6):1220-1227. DOI:10.1016/j.ophtha.2015.01.025.
42. Sasore T, Kennedy B. Deciphering combinations of PI3K/AKT/mTOR pathway drugs augmenting anti-angiogenic efficacy in vivo. PLoS One, 2014, 9(8):105280. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0105280. DOI: 10.1371/journal.pone.0105280.

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Choroidal neovascularization secondary to pathologic myopia:a recent update on diagnosis and treatment

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