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.
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.
ObjectiveTo observe the clinical efficacy of digital 3D heads-up display viewing system (3D viewing system) and intraoperative OCT (iOCT) in vitrectomy for myopic foveoschisis (MF).MethodsA retrospective, consecutive case series. From October 2018 to May 2019, Nineteen eyes of 19 consecutive patients with MF diagnosed in Xiamen Eye Center of Xiamen University who underwent vitrectomy were included in this study. There were 7 males and 12 females, with the mean age of 54.47±11.38 years. The average axial length was 30.40±2.30 mm, the mean logMAR BCVA was 0.56±0.31, the mean central foveal thickness (CFT) was 317.80±151.9.32 μm, the mean max retinal thickness (maxRT) was 556.7±143.7 μm. All the surgeries performed combined with 3D viewing system with iOCT. The standard 25G pars planar vitrectomy were performed with removing the posterior vitreous and indocyanine green (ICG) staining of internal limiting membrane (ILM) and air-fluid exchange. Thirteen of 19 eyes underwent fovea-sparing ILM peeling and the other 6 eyes not. The average follow-up was 4.2±1.4 months. All the patients were on regular follow-up to document the changes on BCVA, anatomical changes in macula, CFT and maxRT. Paired t test was used to compare BCVA, CFT and maxRT before and after surgery.ResultsThe fine images of macula were clearly shown on the 3D viewing system in all eyes. The electronic green filter enhanced the contrast sensitivity of ICG stained images. Clear images of macula were captured by iOCT in all eyes. The average surgical time was 35.5±8.2 min. On the last follow-up, 16 of 19 eyes with MF resolved. The mean CFT was 178.5±103.5 μm, the maxRT was 341.8±83.8.16 μm, and the mean logMAR BCVA was 0.35±0.22. The differences of CFT, maxRT and logMAR BCVA before and after surgery were statistically significant (t=4.181, 7.154, 5.129; P＜0.001). Minimal invisible full thickness macular hole were detected in 2 eyes by iOCT and repaired with auto serum or ILM flap covering. There was no complication associated with the 3D viewing system.Conclusions3D viewing system provides improved contrast and crystal clear macular image stain with ICG in pathological myopia. iOCT can detect the minimal invisible full thickness macular hole during surgery. Both may contribute to improved MF closure rate and BCVA.
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 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.
Objective To evaluate the efficacy of vitrectomy with internal limiting membrane（ILM）peeling and perfluoropropane tamponade (C3F8) to treat macular retinoschisis in high myopic eyes.Methods 33 eyes of 31 consecutive high myopia patients with macular retinoschisis were selected randomly; all had posterior staphyloma without retinal detachment. The preoperative refractive errors ranged from －9.5D to －21.0 D with the mean of －(13.1plusmn;3.6) D. The preoperative axial lengths ranged form 26 mm to 32 mm with the mean of (28.3plusmn;2.1) mm. Conventional 20G vitrectomy was performed with ILM peeling and 10% C3F8 infusion, ILM was labeled by Triamcinolone (TA). The best corrected visual acuity (BCVA) and macular structural changes were observed before the surgery, and at 1, 2, 3, 4, 8 months after the surgery. Results Beginning from 1 month after surgery all patients had significant improvement of the macular retinoschisis and BCVA. The macular structure changed very slightly along with the time. The foveal thickness were (327.6plusmn;51.7),(165.2plusmn;22.6),(159.3plusmn;28.7),(167.7plusmn;17.1),(142.7plusmn;13.8) and (169.1plusmn;19.6) mu;m respectively before surgery and 1, 2, 3, 4, 8 months after surgery. The mean foveal thickness was reduced significantly at 18 months followup compared with the preoperational result (t=9.21，9.23，9.21，10.67，9.21; Plt;0.05). The foveal thickness had no significant change at each timepoint after surgery.From 4 months after surgery, recurrence of macular retionoschisis was found in 3 eyes (9.1%).Conclusion Vitrectomy with ILM peeling and C3F8 tamponade is useful to treat macular retinoschisis in high myopic eyes.
The reattachment rate, macular hole (MH) closure rate, visual acuity improvement and re-detachment rate of MH retinal detachment (MHRD) of high myopia are not satisfactory owing to long axis oculi, posterior scleral staphyloma and macular atrophy. At present, minimally invasive vitrectomy surgery combined with the internal limiting membrane flap technique has become popular in the treatment of MHRD, as it can promote MH closure, and significantly improve the outcome of MHRD. However if this method can improve the postoperative visual function is still controversial. The advantage of this technique is that the loosened internal limiting membrane is applied to cover the MH surface to form a scaffold structure similar to the basement membrane. It can stimulate Müller cell gliosis more effectively, and promote tissue filling in the MH which results in MH closure. It can also promote retinal reattachment and reduce the likelihood of retinal re-detachment. This technique is expected to be a standard surgical method for the treatment of MHRD of high myopia in the future. The inserted internal limiting membrane flap technique is relatively easy to perform, induces stable flaps by simple procedures, and can be an essential complement procedure of the inverted internal limiting membrane flap technique. In order to reduce the recurrence rate in the future, it is necessary to further define the indications of different surgical methods and the predictive effects of MH healing mode on the success rate and visual function recovery.
Objective To observe the the clinical characteristics of images of optic coherence tomography (OCT) in highly myopic eyes with retinoschisis. Methods The clincial data of 158 patients (158 eyes) with high myopia diagnosed by examinations of best corrected visual acuity and refraction, indirect stereoscopic ophthalmoloscopy, A/Bscan ultrasonography, and OCT, were retrospectively analyzed. The patients were divided into retinoschisis group and nonretinoschisis group according to the results of OCT (whether the patients had macular reinoschisis at the posterior pole). There were 53 patients (55 eyes, 34.8%) in the former group, and 101 patients (103 eyes, 65.2%) in the latter group. The age, sex, diopter, visual acuity, ocular axial length, and incidence of posterior scleral staphyloma, vitreous traction, and retinal detachment of the two groups were compared. Results B-scan ultrasonography showed posterior scleral staphloma in all of the 158 eyes. OCT indicated that in the 55 eyes in the retinnoschisis group, 15 （27.3%） had inner, 53 （96.4%）had outer, and 7 （12.7%）had middle retinoschisis. The inner and outer one could exist independently or in the same eye, while the middle one was always accompanied by the outer retinoschisis. Two or more types of schisis coexisted in 13 eyes （23.6%）, single outer retinoschisis was found in 40 eyes （72.7%）, and single inner retinoschisis was found in 2 eyes （3.6%）. There were 26 eyes（47.3%）were accompanied with retinal detachment, 13 eyes（23.6%） with macular hole, and 12 eyes （21.8%）with vitreous traction. In the 103 eyes in the nonretinoschisis group， 23 eyes （22.3%）had vitreous traction, 19 eyes （18.4%） had macular hole, and 21 eyes （20.4%）had retinal detachment. The differences of age, diopter and ocular axial length, sex, incidence of macular hole and vitreous traction between the two groups were not statistically significant (Pgt;005）. The visual acuity in retinoschisis group was much lower than that in the nonretinoschisis group （Plt;005）, and the difference of incidence of the retinal detachment between the two groups was significant (Plt;001). 〖WTHZ〗Conclusion 〖WTBZ〗Macular retinoschisis in eyes with high myopia can exist in inner or middle retina, but most of them locate at outer retina.The patients always have poor visual acuity and are often accompanied by other macular lesions such as retinal detachment.
For choroidal neovascularization (CNV) secondary to pathological myopia, intravitreal injection of anti-VEGF has been widely used in clinic and achieved good outcome. However, due to the differences in the demographic characteristics, stages of disease progression and treatment procedure of CNV, the prognosis of the disease is variable. Complete ellipsoid band, smaller baseline choroidal neovascularization and better baseline vision are important predictors of good outcome of anti-vascular endothelial growth factor treatment. Chorioretinal atrophy or complications related to pathologic myopia indicate a poor prognosis. The influence of age, race, previous photodynamic therapy and early treatment on the prognosis of treatment need to be further studied.
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.