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.
Objective To evaluate the correlation between retinal thickness (RT) at the macular area and the axial length (AL) in myopia. Mehtods Optical coherence tomography (OCT) was used to detect the RT at the macular fovea, and at the superior, nasal, inferior, and temporal side of the fovea and parafovea area. The AL of the examined eye was measured by IOL master measuring machine, and the correlation between RT at the macular area and the Al was evaluated. Results The minimum RT in the macular area in the eyes with myopia was (150.90plusmn;22.10)mu;m.The retina at the temporal side of parafovea was the thinnest. The average RT in the areas around the fovea was negatively correlated with the AL, and there was no correlation among the minimum RT, the mean RT at the fovea, and the AL of eye. Conclusions As the AL of eye increases, the RT at the parafovea decreases, while the minimum and the average RT at the fovea remain unchanged. (Chin J Ocul Fundus Dis, 2006, 22: 397-399)
ObjectiveThe aim of this study is to observe the clinical characteristics and surgical effects of macular hole retinal detachment in high myopia patients with pars plana vitrectomy (PPV) and secondary internal limiting membrane (ILM) peeling. MethodsThis was a retrospective study. The clinical data of 15 patients (15 eyes)with macular hole retinal detachment and high myopia, who underwent primary PPV and secondary ILM peeling, were analyzed, including disease history, refraction diopter, ocular axis length, posterior scleral staphyloma, BCVA, macular reattachment and macular hole heeling. There were 3 males (3 eyes) and 12 female (12 eyes), the average age was (60.80±5.85)years. All patients were examined by best corrected visual acuity (BCVA), slit lamp microscopy with 90D pre-lens, indirect ophthalmoscopy, A scan and optical coherence tomography (OCT). After the first PPV and silicone oil tamponade, a shallow retinal detachment around the macular hole, especially around the scleral staphyloma was detected by OCT. During the 2nd surgery to remove the silicone oil, ILM peeling and C3F8 tamponade were performed. ResultsThe average refraction diopter was (-12.6±1.86) D, the average ocular axial length (29.82±0.993) mm and the average disease duration was (5.20±1.24) months. All eyes had total retinal detachment of all four quadrants, choroid detachment and macular choroidal atrophy, and type Ⅱ Curtin posterior scleral staphyloma. After the second surgery, all had retina attached by fundus examination. OCT examination indicated that macular hole closure in 7 eye, macular hole attached and retinal attached in 8 eyes. Their BCVA improved after both the first and second surgery (P=0.000), the BCVA after second surgery was better than that after first surgery (P=0.038). ConclusionsThe clinical characteristic of our series of patients were as follows: long history, with choroidal detachment and type Ⅱ Curtin posterior scleral staphyloma. All 15 eyes showed retinal attached after secondary ILM peeling. The secondary ILM peeling and C3F8 tamponade may improve the visual outcome and retinal reattachment rate.
ObjectiveTo observe the changes of retinal and choroidal blood flow density and thickness in macula of different myopic dioptre eyes, and to analyze the correlation between retinal and choroidal blood flow density and axial length (AL). MethodsA retrospective clinical study. From October 2022 to May 2023, 86 eyes of 56 myopic patients scheduled for refractive surgery in Department of Ophthalmology, PLA Central Theater CommandGeneral were included into the study. According to the equivalent spherical specular degree (SE), 19, 21, 27 and 19 eyes of low myopia group (group A), moderate myopia group (group B), high myopia group (group C) and super high myopia group (group D) were observed. Optical coherence tomography angiography (OCTA) and AL measurement were performed in all patients. The diopter was expressed in SE. AL was measured by ultrasonic bio-meter. OCTA scanner was used to scan the macular region in the range of 3 mm × 3 mm. The software automatically divided the macular region into two concentric circles with the fovea as the center, which were 1 mm in diameter respectively, the paracentric fovea of 1-3 mm was divided into 5 regions: superior, nasal, inferior and temporal. The superficial capillary plexus (SCP), deep capillary plexus (DCP), choroidal capillary plexus (CC), choroidal blood flow density, retinal and choroidal thickness were measured. The correlation between AL and blood flow density and thickness was analyzed by Pearson correlation analysis. ResultsThere was no significant difference in SCP blood density and DCP blood density in the fovea in groups A, B, C and D (P＞0.05) .There were significant differences in DCP flow density among superior, nasal, inferior and temporal areas (P＜0.05), the difference was significant (P＜0.05). There was no significant difference in the fovea area between the four groups (P＞0.05), but there was significant difference in the superior, nasal, inferior and temporal areas (P＜0.05). Different macular regions: there were statistically significant among group A, group B, and group C, group D (P＜0.05). Results of correlation analysis, AL was negatively correlated with DCP blood flow density (r=−0.504, −0.500, −0.460, −0.465), retinal thickness (r=−0.348, −0.338, −0.312, −0.230), macular subarea CC (r=−0.633, −0.666, −0.667, −0.710, −6.82), choroidal layer (r=−0.635, −0.687, −0.659, −0.703, −0.680) and choroidal thickness (r=−0.665, −0.605, −0.656, −0.648, −0.643) (P＜0.05). ConclusionsAL is negatively correlated with DCP, CC, CDF, retinal and choroidal thickness in the eyes with myopia. SCP, DCP and retinal thickness in fovea did not change significantly, and temporal choroidal thickness changed earlier than other areas.
Objective To observe the clinical effects of surgical treatment of retinal detachment(RD) caused by macular hole(MH) in high myopia. Methods The clinical materials of 149 eyes of 149 high myopia patients with RD caused by MH were reviewed. The cases were divided into complete posterior vitreous detachment (PVD) group and incomplete PVD group. The anatomic successful rate of operative treatment was evaluated according to the applications of vitrectomy surgery and non-vitrectomy surgery respectively in each group. The visual acuity changes after the operations were also observed.Results The anatomic successful rates were as follow: 77.9% in total cases with vitrectomy surgery and 25.9% with non-vitrectomy surgery (P＜0.001); 75.5% in cases of incomplete PVD with vitrectomy surgery,and 15.0% with non-vitrectomy surgery (P＜0.001); and in non-vitrectomy cases, 57.1 % in complete PVD group and 15.0% in incomplete PVD group (P=0.05). The rates of visual improvement were 68.6% in complete PVD group and 57.0% in incomplete group (P＞0.05). Conclusions The scleral buckling combined with vitrectomy, gas intraocular tamponade and postoperative photocoagulation is an effective and optimal procedure for RD caused by MH in high myopia. (Chin J Ocul Fundus Dis，2003，19：8-10)
ObjectiveTo observe the efficacy of vitrectomy combined with internal limiting membrane (ILM) peeling and scleral shortening for myopic foveoschisis (MF).MethodsProspective and non-randomized concurrent control study. A total of 35 MF patients (35 eyes) were enrolled in this study. The patients were divided into 2 groups according to surgery, including group A (18 eyes) and group B (17 eyes), all received vitrectomy combined with ILM peeling, but group A also received scleral shortening. The best corrective visual acuity (BCVA) examination using the Snellen vision chart was converted to the minimum resolution logarithm (logMAR). Ocular axis length (AL) was measured by Zeiss IOL-Master or A-scan ultrasound (Quantel Medical, France). The maximal value of retinal foveoschisis (MxFT) was measured by frequency-domain optical coherence tomography (Heidelberg, Germany). Multifocal electroretinogram (mfERG) responses were obtained with the RETIscan system (Roland Consult, Gemany).There was no statistically significant difference between the two groups (P＞0.05) in age (t=0.460), AL (t=1.520), diopter (t=0.020), logMAR BCVA (t=−2.280), MxFT (Z=−4.179) and b-wave ERG amplitude (Z=−0.198). The changes of BCVA, AL, MxFT and b wave amplitude were followed-up for 3-12 months.ResultsAt the last follow-up, the height of MF was decreased in 18 eyes of group A, and MF was completely disappeared in 4 eyes. The logMAR BCVA (t=7.272, 5.951), MxFT (Z=−3.724, −3.622) and b- wave ERG amplitude (Z=−3.223, −3.243) in both groups A and B were statistically improved (P=0.000, 0.000, 0.000, 0.000, 0.001, 0.001) compared to pre-operational results. There was significant difference of logMAR BCVA (t=−2.280) and MxFT (Z=−4.179) between the two groups (P=0.029, 0.000). But there was no significant difference in the amplitude of b-wave（Z=−0.198, P=0.843). The AL in group A was shortened after surgery, the difference was statistically significant (t=10.017, P=0.000). During the follow-up, there was no ocular hemorrhage, endophthalmitis and other complications.ConclusionPPV combined with ILM peeling and scleral shortening can shorten AL significantly for MF patients, and gain relative normal anatomical structure of the fovea, thus improve the vision.
Pathological myopia, characterized by progressive elongation of the axial length and formation of posterior staphyloma, is accompanied by chorioretinal irreversible degeneration. It is also the focus and biggest challenge of myopia control and blindness prevention. For managing progressive early-onset pathologic myopia and myopic traction maculopathy, episcleral pressurization of macula is a practical option. It can be divided into posterior scleral reinforcement surgery and macular buckling surgery according to the presence or absence of operative top pressure ridge after surgery, both of which are different in terms of implanted materials, procedures and indications. The implanted materials, procedures and indications are different between the two. Under the background of soaring prevalence of myopia, it is necessary to modify and cautiously popularize the techniques of episcleral pressurization of macula to provide high level clinical evidence for management of pathological myopia.
Objective To systematically review the association between Chinese eye exercises and myopia onset in children and adolescents to provide a theoretical basis for clinical prevention of myopia. Methods The PubMed, Web of Science, EMbase, The Cochrane Library, CNKI, VIP, WanFang Data and CBM databases were searched from inception to March 2022 to collect observational studies about the association between Chinese eye exercises and myopia onset in children and adolescents. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 28 studies were included, including 217 112 subjects. The results of meta-analysis showed that doing eye exercises, doing eye exercises ≥2 times per day, doing eye exercises regularly or consistently, doing eye exercises seriously and doing eye exercises correctly and normatively were the protective factors of myopia onset in children and adolescents. Conclusion Current evidence shows that doing eye exercises, doing eye exercises ≥2 times per day, doing eye exercises regularly or consistently, doing eye exercises seriously, doing eye exercises correctly and normatively can prevent myopia onset in children and adolescents. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.