Dome-shaped macula (DSM) of high myopia has been described as an inward convexity or bulge of the macular within the concavity of the posterior staphyloma in highly myopic eyes, with the bulge height over than 50 μm, which can be observed by optical coherence tomography. There are three patterns of DSM, including the typical round dome, the horizontally oriented oval-shaped dome and the vertically oriented oval-shaped dome. The pathogenesis of DSM development remains unclear, several hypotheses have been suggested, such as localized choroidal thickening in the macular area, relatively localized thickness variation of the sclera under the macula, resistance to deformation of sclera staphyloma, ocular hypotony and tangential vitreoretinal traction. Vision-threatening macular complications of DSM including serous retinal detachment, choroidal neovascularization, foveoschisis and retinal pigment epithelial atrophy. Clinically, asymptomatic patients with DSM mainly take regular follow-up observation. Appears serous retinal detachment and significant visual impairment, treatment with half-dose photodynamic therapy, supplementary of laser photocoagulation or oral spironolactone may have a beneficial effect. However, more large clinical studies are required to confirm the exact efficacy of these treatments.
The main fundus changes of pathologic myopia (PM) are posterior staphyloma (PS) and myopic maculopathy (MM), which includes myopic atrophy maculopathy (MAM), myopic tractional maculopathy (MTM), myopic neovascular maculopathy (MNM) and so on. The clinical manifestations of PM-related fundus lesions are complex, and the classification of PM has been a research hotspot in recent years. The proposal of each classification shows an increasing understanding of PM, and each classification has its advantages but also imperfections. For MM, it is recommended to refine the MTM classification based on the ATN classification and adjust it according to the internal correlation between MAM and MNM. The rapid development of modern imaging technology will promote the continuous update of the classification, and its further improvement will also help to understand the development process of PM, which has important clinical value in preventing its occurrence and progression.
Objective To observe the changes of anatomic structure and visual function after surgery in highly myopia patients with macular hole and retinal detachment (MHRD). Methods Twentyfive patients (25 eyes) with MHRD who underwent vitreous and internal membrane peeling surgery combined with silicone oil tamponade, were enrolled in this study. All the patients had undergone the examinations of logarithm of minimal angle of resolution (logMAR) visual acuity, optical coherence tomography (OCT), MP-1 microperimetry and multifocal electroretinogram (mf-ERG) before and three months after surgery. The visual acuity, structure of macular hole and macula, fixation point, mean sensitivity (MS) within 10° of macular area and four quadrants including supertemporal, supernasal, intranasal and infratemporal, average response densities of N1 and P1 waves at all 6 rings before and after surgery were observed. Results Three months after surgery, the logMAR visual acuity improved (t=8.265， P＜0.05). Twentyfour eyes (96%) were anatomically reattached, one eye (4%) was not anatomically reattached completely. The results of MP-1 microperimetry showed that foveal fixation was found in two eyes (8%), weak foveal fixation was found in four eyes (16%), paracentral fixation was found in 19 eyes (76%). There were four eyes (16%) with stable fixation, nine eyes (36%) with relatively unstable fixation and 12 eyes (48%) with unstable fixation. The MS value within 10° of macular area was 9.031±4.245 dB. The MS value difference among four quadrants was statistically significant (F=7.40，P=0.015). The mf-ERG results showed that the average response densities of N1 and P1 waves at all 6 rings were increased (P＜0.05). Conclusion The macular hole heals, retina remains reattached, visual acuity, and fixation are improved in the most of MHRD eyes after surgery.
Objective To observe the abnormal expression of transthyretin in serum and vitreous of high myopia patients. Methods 116 patients (50 males and 66 females) with high myopia, diagnosed by retinoscopic reflex, slit-lamp microscope, indirect ophthalmoscope and Iol-Master, were enrolled. The patients had an average age of (49.7plusmn;12.3) years and average diopter of (-10plusmn;4.2) D. The control group had 86 healthy individuals (42 males and 44 females) with an average age of (48.5plusmn;10.5) years. According to the findings of indirect ophthalmoscope and optical coherence tomography (OCT) examination, the patients were classified as foveal detachment, macular hole, choroidal neovascularization, epimacular membrane, retinal scar and no significant pathological changes. 2 ml peripheral blood samples were taken from all the subjects. The vitreous samples of high myopia patients with foveal detachment and macular hole (20 patients, 20 eyes) were collected before pars plana vitrectomy. LTQ-MASS was performed on 16 serum samples of patients and 16 control serum samples. Western blot and enzyme linked immunosorbent assay (ELISA) were used to detect serum transthyretin expression in high myopia groups（n=100）and control group (n=80). Vitreous samples (n=20) and corresponding serum samples were further analyzed by ELISA. Meanwhile, the relationship between visual acuity after surgery and transthyretin expression level in vitreous were analyzed. Results LTQ-MASS detected 4 proteins differentially expressed in the serum of patients and control group, transthyretin was the most significantly increased protein in high myopia patients. Western blot validated that serum transthyretin of high myopia group was much higher than that of the control group (t=3.68, P＜0.05). High myopia patients with macular hole and macular detachment had much higher serum and vitreous transthyretin than that of control group (F=9.28，P＜0.01). Patients with higher vitreous transthyretin had better postoperative visual acuity. Conclusions The transthyretin level increases significantly in serum and vitreous of high myopia patients, and it correlated with ocular pathologies and visual outcomes.
Objective To observe the microperimetry performance of macular function in pathologic myopia patients. Methods The clinical data of 90 patients (142 eyes) with pathologic myopia were retrospectively analyzed. All patients were asked in details about history, and take examinations of best corrected visual acuity (BCVA), refractive dioptre, eye axis, fluorescent fundus angiography (FFA), indirect ophthalmoscopy and optical coherence tomography (OCT). According to the test results, patients were divided into non-pathological macular group (20 patients, 24 eyes) and pathological macular group (70 patients, 118 eyes). Retinal imaging and macular microperimetry were measure by MP-1 Microperimeter.The mean retinal sensitivities (MS) and fixation stability in the central 10deg;, fixation rate and fixation position in the central 2deg; and 4deg;were determined.Results The MS of pathological and non-pathological macular group were(16.39plusmn;2.12), (10.80plusmn;4.53) dB respectively, the difference was statistically significant(F=15.044,t=-9.314;P=0.000). Among 24 eyes of non-pathological macular group, fixation was stable in 19 eyes (79.17%), relative unstable in five eyes (20.83%); among 118 eyes of pathological macular group, fixation was stable in 45 eyes (38.14%), relative unstable in 52 eyes (44.07%), unstable in 21 eyes (17.79%), the difference was statistically significant(chi;2=13.56, P=0.000). The differences of 2 deg;and 4 deg;fixation rate between those two groups are statistically significant (F=5.773, 13.230; t=-4.110,-5.465;P=0.000) . Among 24 eyes of non-pathological macular group, center fixation occurred in 23 eyes (95.83%), weak center fixation occurred in one eye (4.17%); among 118 eyes of pathological macular group, fixation center occurred in 81 eyes (68.64%), weak center fixation occurred in 16 eyes (13.56%)，eccentric fixation occurred in 21 eyes (17.80%), the difference was statistically significant (F=9.618,t=-5.773；P=0.000).Conclusion Pathological myopia patients with pathological macular changes have decreased retinal sensitivity, decreased fixation stability and eccentric fixation points.
Objective To observe the macular structure changes and its relationship with visual function in patients with idiopathic macular hole (IMH). Methods Forty-seven patients (47 eyes) with IMH who underwent pars plana vitrectomy were enrolled in this study. All patients were examined including bestcorrected visual acuity (BCVA), slit-lamp microscopy, indirect ophthalmoscopy, B-scan ultrasonography, optical coherence tomography (OCT) and MP-1. All the patients underwent a standard three-port pars plana vitrectomy. The BCVA, mean light sensitivity (MS) in macular area, macular hole diameter, the photoreceptor inner and outer segment (IS/OS) junction defect, external limiting membrane (ELM) defect were observed on the 1st, 3rd and 6th months after surgery, and then the relationship of IS/OS junction defect, ELM defect, sensitive and BCVA were analyzed. Results The 1st, 3rd and 6th months after surgery, the logarithm of minimal angle of resolution (logMAR) BCVA (t=16.4, 35.7, 20.7; P＜0.05) and MS （t=－13.8, －17.9, －2.5; P＜0.05） were improved significantly; the macular hole diameter （t=7.7, 7.7, 7.7;P＜0.05）, IS/OS junction defect （t=24.1, 19.3, 27.4; P＜0.05） and ELM （t=20.5, 6.7, 15. 8; P＜0.05） defect were decreased significantly. Preoperative IS/OS junction defect and ELM defect were both related to sensitive （r=-0.55, -0.53; P＜0.05）, but uncorrelated with BCVA （r=0.13, 0.13; P＞0.05）. IS/OS junction defect and ELM defect 1st, 3rd and 6th months after surgery were both related to MS and BCVA （P＜0.05）. Conclusions The logMAR BCVA and MS increases, while IS/OS junction and defect ELM defect decreases after surgery in IMH patients. IS/OS junction defect and ELM defect after surgery were both related to sensitive and BCVA.
ObjectiveTo observe the anatomical and functional changes in patients with different degrees of myopic traction maculopathy (MTM) after vitrectomy. MethodsIt was a retrospective case series study. Forty-seven consecutive patients (47 eyes) diagnosed with MTM were studied between January 2010 and May 2014. There were 38 females (38 eyes) and 9 male (9 eyes),mean age was (65.13±6.98) years, mean axial length was (29.23±1.77) mm. The eyes was divided into 3 groups according to the macular morphologies on optical coherence tomography (OCT), including macular retinoschisis only group (MRS group, 18 eyes), foveal retinal detachment group (FD group, 13 eyes) and full-thickness macular hole group (MH group, 16 eyes). All the eyes underwent minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA), intraocular pressure, axial length, A or B- ultrasonography, fundus photography, OCT and microperimetry examinations. The average logMAR BCVA of 47 eyes was 1.43±0.52. The center retinal thickness (CRT) of eyes in MRS and FD group was (528.45±167.61) μm. All the patients underwent pars plana vitrectomy combined with internal limiting membrane peeling. The mean follow-up period was 23.4 months. The changes of logMAR BCVA, microperimetry and macular microstructural were observed. ResultsAt the final follow-up, the logMAR BCVA of 47 eyes was 0.86±0.42, which improved compared with the preoperative vision (t=7.36,P<0.001). The mean CRT of eyes in MRS and FD group was (250.90±91.81) μm, which improved compared with the preoperative CRT (t=8.17,P<0.001). In MRS group, the retina was attached in 18 eyes. In FD group, the retina was attached in 11 eyes, MH was observed in 2 eyes. In MH group, recurrent retinal detachment was observed in 1 eye. The differences of logMAR BCVA and retinal sensitivity among MRS, FD and MH groups were significant (χ2=6.38, 11.08; P=0.030, 0.004). ConclusionThe macular structural and visual function in MTM eyes with macular retinoschisis only after vitrectomy are better than those in MTM eyes with MH and foveal retinal detachment.
ObjectiveTo analyze the diagnostic value of multicolor scanning laser imaging (confocal scanning laser ophthalmoscopy, cSLO) combined with swept-source optical coherence tomography (SS-OCT) for lacquer cracks (LC) and myopia stretch lines (MSL) of pathological myopia.MethodsA observational study. A total of 83 eyes of 58 patients with pathological myopia were recruited from May 2017 to January 2018 in Department of Ophthalmology of The First People’s Hospital Affiliated to Shanghai Jiao Tong University. Among 58 patients, 20 were males (30 eyes) and 38 were females (53 eyes). The mean age was 50.65±12.02 (range from 24 to 70) years old; the average BCVA was 0.37±0.32; the average diopter was −11.38±4.96 D; and the average axial length was 28.91±2.15 mm. All participants underwent FFA and ICGA examination to obtain FFA, ICGA, infrared light reflection (IR) and autofluorescence (AF) images. SS-OCT was applied for scanning macular and optic disc at 9 mm × 9 mm range. cSLO was performed with macular as the center. All images were inspected carefully by three independent observers and the consistency test was detect. LC were diagnosed as hyperreflective line in FFA and hypofluorescent linear lesions in late ICGA. MSL were defined as both hypofluorescent linear lesions in FFA and late ICGA. The accuracy of each inspection item in the diagnosis of LC was detected. The optimal technique was applied with SS-OCT to further explore the detection rate of LC.ResultsThe intra-observer reproducibility was good to excellent for all measurements (Kappa=0.938, P＜0.01). The positive detection rate of LC and MSL was highest in the standard images of cSLO (77.1%), followed by SS-OCT red free (73.1%), fundus photography (72.3%), IR (72.3%) and AF (49.4%). The cSLO was optimal in the test consistency (Kappa=0.520, P＜0.01) and accuracy (the area under the receiver operating characteristic was 0.750). SS-OCT and cSLO were jointly applied to diagnosis of LC and MSL in high myopia. The positive detection rate of LC, MSL and LC+MSL were 91.7%, 91.2% and 93.3% respectively. The characteristics of LC in SS-OCT were irregularities and discontinuous of the RPE-Bruch membrane line, discontinuous inner ellipsoid zone, thinner choroid, an increased light penetrance into deeper tissues, and RPE fracture in severe cases. MSL was mainly manifested as RPE clumps, visible large choroidal vessels protruding and pushing the overlying RPE toward the vitreous.ConclusionsThe diagnosis rate of LC in pathological myopia by cSLO is 77.1%. The standard images of cSLO combined with SS-OCT can diagnose LC, MSL and LC+MSL at rates of 91.7%, 91.2% and 93.3% respectively.
Objective To investigate the prevalence of high myopia，the prevalence and risk factors of high myopia associated with chorioretinopathy in residents aged 60 years or over in Beixinjing community, Shanghai, China.Methods A cluster stratified random sampling method was used to screen 4153 people aged 60 and over in Beixinjing community. There were 3851participants in total with a 9273% response rate. Participants were invited to complete a questionnaire and received a comprehensive eye examination including visual acuity, refraction, slitlamp microscopic examination, direct ophthalmoscopy and fundus photography and so on. Spherical equivalent (SE) was used to determine the degree of refractive errors. The diagnosis of high myopic chorioretinopathy was made if SEgt;-6.00 D and myopic chorioretinal atrophy lesions were presented such as posterior scleral staphyloma, lacquer cracks, Fuchs spot and myopic arc spots. The degree of visual acuity impairment was determined according to the World Health Organization (WHO) classification as low vision (the best corrected visual acuity ge; 0.05, but lt;0.3) or blindness (the best corrected visual acuity lt;0.05).Results There were 207/3851(5.37%) high myopia patients, in which 183/207 (88.40%) patients were associated with myopic chorioretinopathy. The prevalence of myopic chorioretinopathy decreased while age increased (chi;2=19.21, Plt;0.01), but statistically there was no gender difference （chi;2=1.83, Pgt;0.05）. Logistic regression analysis showed that there were significant differences in the prevalence of high myopia between people with different age, educational levels and family history （chi;2=19.21，32.08，960.68；Plt;0.01）.There were 29 cases of bilateral blindness, 96 cases of unilateral blindness,104 cases of bilateral low vision and 562 cases of unilateral low vision in those participants. In 183 cases of high myopic chorioretinopathy patients, 111（60.65 %）cases had an obvious visual impairment, including 3448% (10 cases) of bilateral blindness, 1146% (11 cases) of unilateral blindness, 2981% (31 cases)of bilateral low vision and 1050% (59 cases) of unilateral low vision.Conclusions The prevalence of high myopia of residents aged ge;60 years in Beixinjing community, Shanghai,China is relatively high. Age, education level and family history are the most important factors affecting the occurrence of chorioretinopathy in high myopia patients.