Objective To observe the characteristics of fundus fluorescein angiography (FFA) in different types of pathologic myopic maculopathy and evaluate the influence factor.Methods The clinical data of 251 patients (451 eyes) with pathologic myopic maculopathy were retrospectively analyzed. The patients were divided into 6 groups according to FFA characteristics: (1) lacquer cracks (LC); (2) choroidal neovascularization (CNV); (3) macular hemorrhage with LCs; (4) Fuchs spots; (5) macular atrophy; (6) macular hole. Their relationship with age, gender, refraction and (BCVA) were analyzed.Results Older age was significantly associated with CNV and macular atrophy (OR=1.034,CI=1.019-1.049,P＜0.001;OR=1.054,CI=1.031-1.076,P＜0.001; respectively);younger age was associated with hemorrhage with LC (OR=0.906,CI=0.876-0.937,P＜0.001). Higher myopic refractive error was associated with macular atrophy (OR=0.762,CI=0.705-0.824,P＜0.001), whereas lower myopic refractive error was associated with CNV and macular hole(OR=1.233,CI=1.136-1.338,P＜0.001;OR=1.554,CI=1.185-2.038,P＜0.001; respectively). A worse visual acuity was associated with CNV (OR=1.835,CI=1.180 -2.854,P=0.007), while better visual acuity was associated with LC (OR=0.506,CI=0.328 - 0.782,P=0.002). There was no gender difference in distribution of high myopic maculopathy types. Conclusions Pathologic myopic maculopathy can be divided into six types. With increasing age, the incidence rates of CNV and macular atrophy increases, hemorrhage with LC but decreases. With the rise of myopic refractive, the incidence rates of CNV and macular hole decreases, macular atrophy but increases.
Objective To observe the efficacy of photodynamic therapy (PDT) for choroidal neovascularization (CNV) secondary to pathological myopia (PM).Methods Sixty-six patients (73 eyes) with CNV secondary to PM who had undergone PDT were enrolled in this study. PDT was performed according to the standard treatment. The patients received the examinations of best corrected visual acuity (BCVA), ophthalmoscopy, fundus fluorescein angiography (FFA) and/or indocyanine green angiography (ICGA), and optical coherence tomography (OCT) before and after the treatment.Vision results were converted into logMAR records and compared before and after the treatment. The complete records of FFA were found in 52 eyes. FFA findings, treatment effects, were judged as well, moderate or poor according to the CNV leakage or bleeding, and CNV expanding or shrinking. The complete records of OCT were found in 11 eyes. CNV regional edema and foveal thickness were analyzed based on OCT examination.Results The mean logMAR BCVA after PDT treatment was 0.74plusmn;0.51 with no significant difference compared with before treatment (t=1.11, P=0.27). There were 18 eyes (24.7%) with improved vision, 43 eyes (58.9%) with stable vision, and 12 eyes (16.4%) with decreased vision. In 52 eyes with FFA findings, 39 eyes (75.0%) with well effect, 9 eyes (17.1%) with moderate effect, and 4 eyes (7.7%) with poor effect. OCT showed that after treatment the CNV regional edema subsided in most of eyes, and there were 7 (63.64%) with decreased foveal thickness, 2 (18.18%) with stable thickness, and 2 (18.18%) with increased thickness. Conclusions PDT is an effective treatment for CNV secondary to PM. It may improve or stabilize the visual acuity.
Objective To evaluate the clinical features of macular retinoschisis (MRS) and macular retinal detachment without hole (MRDH) in highly myopic eyes. Methods The clinical data of 19 patients (24 eyes) with MRS and MRDH from 186 patients (349 eyes) with high myopia were retrospectively analyzed. All of the patients had undergone the examinations of subjective refraction, binocular indirect ophthalmoscope, slit lamp microscope combined with Goldmann threemirror contact lens, fundus images, A/Bscan ultrasonography, and optical coherence tomography (OCT). Results In 349 eyes, 24 (6.9％) had MRS and (or) MRDH at the posterior pole. The results of ocualr fundus examinations showed that all of the 24 eyes (100%) had posterior scleral staphyloma (PS), 2 (8.3%) had vitreomacular traction (VMT), 2 (8.3%) had macular local superficial retinal detachment, and 1 (4.2%) had fullthickness macular hole. The results of Bscan ultrasonography also indicated PS in all 24 eyes (100%), macular local superficial retinal detachment in 7 (29.2%) with a bowlike configuration formed by the detached retina and the coneshaped roof of PS, and VMT in 2 (8.3%). The results of OCT revealed macular outerlayer retinoschisis (ORS) in 22 eyes (91.7%) in which 8 (36.4%) also had macular innerlayer retinoschisis (IRS); MRDH in 5 eyes (20.8%) in which ORS was found in 3 (60.0%) and simplex MRDH in 2 (40.0%) including 1 with VMT; VMT in 13 eyes (54.2%); cystoid macular edema (CME) in 3 eyes (12.5%); and lamellar macular hole in 4 eyes (16.7%). Conclusions MRS and MRDH are common complications in highly myopic eyes with posterior scleral staphyloma.OCT is more sensitive and accurate in detecting MRS and MRDH than routine ophthalmoscopic examination and B-scan ultrasonography.
Objective To observe the therapeutic effect of combined surgery of anterior and posterior segment and silicon oil tamponade on macular hole retinal detachment in eyes with high myopia.Methods The clinical data of 48 high myopia patients (48 eyes) with macular hole retinal detachment were retrospectively analyzed. Retinal detachment was mainly at the posterior pole; macular hole was confirmed by noncontact Hruby lens and optical coherence tomography (OCT). Phacoemulsification combined with pars plana vitrectomy and silicon oil tamponade were performed to all patients, of which 41 had undergone internal limiting membrane peeling, and 23 had intraocular lens implanting. The oil had been removed 3.5-48.0 months after the first surgery and OCT had been performed before the removal. The followup period after the removal of the silicon oil was more than 1 year.Results The edge of the macular hole could not be seen under the noncontact Hruby lens 1 week after the surgery in all but 5 patients, and the visual acuity improved. The silicon oil had been removed in all of the 48 patients; the OCT scan before the removal showed that the closed macular holes can be in U shape (8 eyes), V shape (6 eyes) or W shape (23 eyes). About 1338 months after the oil removal, retinal detachment recurred in 2 patients with the Wshaped holes. At the end of the followup period, 16 patients (33.3%) had U or Vshaped macular holes, and 32 patients (66.7%) had Wshaped macular holes. The rate of retinal reattachment was 100%.Conclusion Combined surgery of anterior and posterior segment and silicon oil tamponade is effective on macular hole retinal detachment in eyes with high myopia.
Pathological myopic macular retinoschisis can be classified into 4 types based on optical coherence tomography (OCT) images: outer layer retinoschisis, outer + middle layer retinoschisis, outer + inner layer retinoschisis and multilayer retinoschisis. Currently vitrectomy is the major option to treat this condition as it can remove the posterior vitreous cortex completely and peel the internal limiting membrane (ILM) around the posterior vessels arch. Vitrectomy benefits the visual function significantly for outer layer retinoschisis with foveal detachment, but has no or very little effects on multilayer retinoschisis. The appropriate starting site for removal of posterior cortex and ILM should be the site without inner layer retinoschisis. The knowledge and understanding of the OCT classification of pathological myopic macular retinoschisis is important for us to chose correct operation methods and determine the prognosis after treatment.
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.
Myopic macularpathy is the main cause of the decline of visual function in high myopia, which including tigroid fundus, lacquer cracks, diffuse retinal choroid atrophy, plaque retinal choroid atrophy, choroidal neovascularization (CNV), Fuchs spot and posterior staphyloma. The tigroid fundus is the initial myopic retinopathy. The lacquer cracks is a special lesion in the posterior pole of high myopia. When the lacquer cracksen enlarge or lacquer cracks progress to plaque retinal choroid atrophy should be paid to monitoring the occurrence of CNV. Myopic macularpathy progression include two mode. One is from tigroid fundus——lacquer cracks——plaque retinal choroid atrophy——CNV to macular atrophy. And the other is from tigroid fundus——diffuse retinal choroid atrophy——atrophy enlarge to diffuse retinal choroid atrophy with plaque retinal choroid atrophy or plaque retinal choroid atrophy occurence on the border of posterior staphyloma. Understanding the progression patterns and natural course of these lesions will help the clinic to further understand the course of high myoipa.