Peripapillary intrachoroidal cavitation (PICC) is a common pathological change observed in high myopia. The exact pathogenesis of PICC is still unclear. Expansion and mechanical stretching of the peripapillary sclera, breakage and defect in the retina near the border of the myopic conus and communication between intrachoroidal cavity and the vitreous space may be important segments during the development of PICC. Color fundus photography shows a localized and well-circumscribed peripapillary lesion with yellow-orange colour, often accompanied by fundus changes, such as myopic conus excavation, optic disc tilting and inferotemporal retinal vein bending at the transition from the PICC to the myopic conus. However, the PICC lesion is not easy to be recognized in the fundus photography. Fluorescein angiography shows early hypofluorescence and later progressively staining in the lesion. Indocyanine green angiography shows hypofluorescence throughout the examination. Optical coherence tomography (OCT) is vital in diagnosing PICC. Hyporeflective cavities inside the choroid, sometimes communicating with the vitreous chamber, can be observed in OCT images. OCT angiography indicates lower vessel density or even absence of choriocapillary network inside or around PICC lesions.
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.
ObjectiveTo objectively quantitative assess the visual quality in patients with myopic foveoschisis (MF) using a double-pass optical quality analysis system (OQASⅡ). MethodsSixty-two subjects participated in this cross-sectional, observational study, who were divided into three groups based on the pathologic conditions including myopic foveoschisis group (MFG), myopic control group (MCG) and normal control group (NCG). Measurements with OQASⅡwere performed for the modulation transfer function cut off frequency (MTF cut-off), the Strehl ratio (SR) and the objective scatter index (OSI). Visual data were analyzed using ANOVA and Pearson's correlation accompanied by logMAR BCVA and axial length (AL). ResultsThe mean values for MTF cut-off, SR and OSI of MFG, MCG and NCG were 18.18±4.81, 0.13±0.03, 3.50±0.44; 22.87±2.66, 0.14±0.02, 2.42±0.29; 33.68±4.70, 0.23±0.02, 1.68±0.20 respectively, and statistical difference were proved except SR between MFG and MCG, or BCVA between MCG and NCG (P < 0.05). LogMAR BCVA and AL have negative correlations to MTF cut-off (r=-0.928, -0.658; P < 0.05) and SR (r=-0.577, -0.893; P < 0.05) with high coefficients in MFG. Log MAR BCVA has negative correlations to MTF cut-off and SR (r=-0.659, -0.806; P < 0.05) in MCG. Log MAR BCVA has negative correlations to MTF cut-off and SR (r=-0.606, -0.602; P < 0.05) and positively correlated to OSI (r=0.561, P < 0.05) in NCG. ConclusionsThe mean value of BCVA, MTF cut-off, SR, OSI of myopic foveoschisis patients were lower than those myopic patients without foveoschisis and normal people. there exists a significant negative correlation between Log MAR BCVA, AL to MTF cut-off and SR. Compared with myopic and normal subjects, myopic foveoschisis have lower BCVA, MTF cut-off, SR but higher OSI.
High myopia is frequently associated with retinal degenerative changes (such as myopic foveoschisis, macular hole and its related retinal detachment, and choroidal neovascularization) which are the major causes of visual loss in high myopic eyes. Optical coherence tomography may help us to understand the macular lesions in high myopia. Peeling of internal limiting membrane and removal of posterior vitreous cortex at an appropriate time, are believed to facilitate restoring the retinal flexibility and resolution of myopic foveoschisis, and promote the macular hole closure and retinal reattachment. Antiangiogenesis treatment combined with photodynamic therapy and (or) corticosteroid therapy are the future options to treat myopic choroidal neovascularization. Correctly understanding and mastering the methods and timing of diagnosis and treatment of high myopiarelated macular degeneration, and taking targeted interventions to enable patients to be rational and effective treated, are the keys to further reduce the damage of visual function in patients with high myopia.
ObjectiveTo evaluate the clinical curative effect of posterior scleral reinforcement for macular retinoschisis in pathological myopic patients. MethodsA prospective study was conducted, in which 36 pathological myopia patients(36 eyes)with myopic foveoschisis were enrolled and divided into two groups according to the treatments: 24 patients (24 eyes) voluntarily underwent posterior scleral reinforcement (PSR, operation group) and 12 patients (12 eyes) didn't receive operation (control group). There are no statistical differences (P>0.05) in age, gender, length of axis oculi, spherical equivalent between the 2 groups. All patients were examined by best corrected visual acuity (BCVA), macular retinoschisis types, central foveal thickness (CFT), maximum foveal thickness (MxFT). Patients in operation group were scheduled to a follow-up 3rd, 6th, and 9th month after surgery respectively. Patients in control group all were followed up once every three months. A contrast observation was made on the changes of BCVA, CFT, MxFT, findings of the foveoschisis and the complications of the surgery between groups. ResultsCompared with the preoperation after 9 month follow-up: in the operation group, the BCVA was significantly increased postoperatively (Z=-3.43, P=0.01), the mean CFT was significantly decreased postoperatively (Z=-2.71, P=0.007), while the MxFT which was not significantly decreased postoperatively (Z=-0.67, P=0.503). In the control group, there was no significant change in BCVA (Z=-1.840, P>0.05), the CFT and the MxFT were signi? cant increased respectively (Z=-2.803, -2.04; P<0.05). In the operation group, there were 6 (25.0%) of the 24 eyes get complete resolution of the foveoschisis; 16 (66.7%) of them is not completely attached however the retinoschisis was significantly decreased; only 2 eyes developed to macular hole the other getting worse and the foveal thickness was increased. In the control group no one get complete resolution of the myopic foveoschisis, and 2 eyes developed to retinal detachment in 6 and 8 month respectively. There was no complications such as post-operative intra-ocular pressure increased, subretinal hemorrhage, macular epiretinal membrane, endophthalmitis, vortex vein circumfluence obstacle and anterior ocular ischemia syndrome occurred after surgery. ConclusionsPosterior scleral reinforcement surgery was found effective in improving the visual acuity, reducing the CFT. No obvious complications were found during and after the surgery.
Objective To investigate the distribution of the preferred retinal locus (PRL) of eccentric fixation in eyes with high myopia.Methods A total of 40 highly myopic patients (54 eyes ) with eccentric fixation were examined by MP1 microperimeter to identify the PRL. The position of PRL relative to the fovea was estimated using the 90% confidence ellipse of normal adult foveal fixation. The differences of visual acuity between ldquo;desirablerdquo; and ldquo;undesirablerdquo; PRL were tested by analysis of variance.Results In 54 eyes with high myopia, 24 eyes (44.44%) had PRL of eccentric fixation below the scotoma after loss of central vision; 19 eyes ( 35.19% ) had a leftfield PRL; 6 eyes ( 11.11% ) had an upperfield PRL; and 5 eyes ( 9.26% ) had rightfield PRL. In 14 patients who had binocular eccentric fixation, 13 had the same fixation pattern in both eyes, including lowerfield PRL in 7 （50.00%）, leftfield PRL in 5 （35.71%）, and upperfield PRL in 1 patient （7.14%）. The difference of visual acuity between lower and leftfield PRL group and right and upperfield undesirable PRL group was not statistically significant（F=0.144, Pgt;0.05）. Conclusions The eccentric fixation in eyes with high myopia is usually situated as near as possible to the fovea. The optimal PRL is inferior visual field.
Objective To observe the therapeutic effect of pars plana vitrectomy (PPV) on myopic traction maculopathy (MTM).Methods The clinical data of 31 eyes of 29 patients with MTM diagnosed by timedomain optical coherence tomography (TDOCT) and slitlamp ophthalmoscopy were retrospectively analyzed. The cases were divided into 2 groups according to the stage of MTM: 12 eyes of 10 patients at the early stage of MTM were in group 1; 19 eyes of patients at the most Advanced stage of MTM were in group 2. All of these eyes had undergone PPV with 10％15％ inert gas filling. The patients were followed postoperatively for 6 to 12 months with the average of 8 months, and the best corrected visual acuity, reattachment of macular and retina was examined. Results The improvement rate of visual acuity after surgery for 6 months was 100% in group 1, and 63.2% in group 2 had (12/19); the visual acuity in group 1 was apparently better than that in group 2 (Z=-5477, P=0000). The macular hole disappeared without exposure of the pigment epithelium in all eyes of Group 1, but only 3 eyes in Group 2. For Group 2 patients, 3 eyes had reattached retina with macular holes, and 3 eyes had detached retina with macular holes. The recovery of macular configuration in Group 1 was obviously better than that in Group 2 (Z=-4318, P=0000). Conclusion The surgical intervention of MTM before the formation of macular hole and retinal detachment may prevent the formation of macular holes.
Objective To compare the efficacy of intravitreal injection of ranibizumab and bevacizumab in the treatment of pathological myopia choroidal neovascularization (PM-CNV). Methods It is a retrospective case study. Seventy-nine patients (79 eyes) with PM-CNV were enrolled in this study. There were 26 males (26 eyes) and 53 females (53 eyes), with the mean age of (30.77±5.53) years. The best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscope, fundus color photography, fundus fluorescein angiography, and optical coherence tomography (OCT) were performed. BCVA was recorded as logarithm of the minimum angle of resolution (logMAR). The central retinal thickness (CMT) was measured by OCT (Cirrus HD-OCT). The eyes were divided into bevacizumab treatment group (38 eyes) and ranibizumab treatment group (41 eyes). There was no difference of the mean logMAR BCVA, intraocular pressure and CMT between two groups (t=−0.467, −1.983, 1.293;P=0.642, 0.051, 0.200). The eyes in bevacizumab treatment group were treated with bevacizumab 0.05 ml (1.25 mg), and the eyes in ranibizumab treatment group were treated with ranibizumab 0.05 ml (0.5 mg). Times of injection between two groups were compared. The changes of intraocular pressure were observed at 1, 7 days and 1 month after treatment. The changes of logMAR BCVA and CMT at 1, 3, 6, 12 and 24 months after treatment and systemic adverse reactions occur were compared. Results At the 1, 3, 6, 12 and 24 months after treatment, the mean logMAR BCVA of the bevacizumab treatment group and the ranibizumab treatment group was significantly improved than that before treatment (F=132.374,P＜0.01). There was no significant difference in the mean logMAR BCVA at different time points between the two groups (F=0.095,P=0.759). The mean CMT of the two groups was lower than that before treatment (F=151.653,P＜0.01). There was no significant difference in the mean CMT between the two groups (F=0.332,P=0.566). No retinal detachment, endophthalmitis, cataract and persistent high intraocular pressure were associated with drug, injection-related eye and systemic adverse events during follow-up. Seven eyes had conjunctiva bleeding after treatment, 11 patients (11 eyes) complained of shadow floaters after treatment. Conclusion Intravitreal injection of bevacizumab or ranibizumab can equally effectively improve the visual acuity and reduce the CMT of PM-CNV patients.
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.
ObjectiveTo observe the long-term clinical effect of pars plana vitrectomy combined with fovea-sparing internal limiting peeling in the treatment of macular foveoschisis in pathologic myopic.MethodsA prospective case series study. Fifteen patients (15 eyes) with pathological myopic macular foveoschisis who received treatment in Eye Hospital of Wenzhou Medical University from December 2015 to December 2016 were enrolled. There were 4 males (4 eyes) and 11 females (11eyes), with an average age of 55.33±8.34 years. All patients underwent BCVA, diopter, spectral domain OCT and axial length measurement. The mean logMAR BCVA was 0.95±0.64. The mean central fovea thickness (CFT) was 576.00±185.32 μm. All patients underwent vitrectomy combined with fovea-sparing internal limiting peeling. After gas-liquid exchange, 12% C3F8 was filled and followed up at 1, 3, 6 and 12 months after surgery. Follow-up time was more than 12 months. The structural changes of BCVA and macular area were observed.ResultsThe foveal internal limiting membranes was successfully preserved in all eyes using the techinique. At the final follow-up, the CFT was 258.60±175.22 μm and the BCVA was 0.46±0.43, which were significantly improved compared with preoperative measurements (t=4.90, 5.20; P＜0.001). Macular foveoschisis was resovled in 13 eyes. BCVA increased in 14 eyes. Internal limiting membranes proliferation and contraction occurred in 5 eyes and full-thickness macular hole occurred in 1 eye.ConclusionsPars plana vitrectomy with fovea-sparing internal limiting peeling is effective in the treatment of myopic macular retinoschisis. It can improve BCVA and CFT.