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 evaluate the macular visual function of patients with myopic choroidal neovascularization (MCNV) before and after intravitreal injection of conbercept.MethodsA prospective, uncontrolled and non-randomized study. From April 2017 to April 2018, 21 eyes of 21 patients diagnosed as MCNV in Shanxi Eye Hospital and treated with intravitreal injection of conbercept were included in this study. There were 9 males (9 eyes, 42.86%) and 12 females (12 eyes, 57.14%), with the mean age of 35.1±13.2 years. The mean diopter was −11.30±2.35 D and the mean axial length was 28.93±5.68 mm. All patients were treated with intravitreal injection of conbercept 0.05 ml (1+PRN). Regular follow-up was performed before and after treatment, and BCVA and MAIA micro-field examination were performed at each follow-up. BCVA, macular integrity index (MI), mean sensitivity (MS) and fixation status changes before and after treatment were comparatively analyzed. The fixation status was divided into three types: stable fixation, relatively unstable fixation, and unstable fixation. The paired-sample t-test was used to compare BCVA, MI and MS before and after treatment. The x2 test was used to compare the fixation status before and after treatment.ResultsDuring the observation period, the average number of injections was 3.5. The logMAR BCVA of the eyes before treatment and at 1, 3, and 6 months after treatment were 0.87±0.32, 0.68±0.23, 0.52±0.17, and 0.61±0.57, respectively; MI were 89.38±21.34, 88.87±17.91, 70.59±30.02, and 86.76±15.09, respectively; MS were 15.32±7.19, 21.35±8.89, 23.98±11.12, 22.32±9.04 dB, respectively. Compared with before treatment, BCVA (t=15.32, 18.65, 17.38; P＜0.01) and MS (t=4.08, 3.50, 4.26; P＜0.01) were significantly increased in the eyes 1, 3, and 6 months after treatment. There was no significant difference in the MI of the eyes before treatment and at 1, 3, and 6 months after treatment (t=0.60, 2.42, 2.58; P＞0.05). Before treatment and at 1, 3, and 6 months after treatment, the proportion of stable fixation were 28.57%, 38.10%, 38.10%, 33.33%;the proportion of relatively unstable fixation were 47.62%, 47.62%, 52.38%, 57.14% and the proportion of unstable fixation were 23.81%, 14.28%, 9.52%, 9.52%, respectively. The proportion of stable fixation and relatively unstable fixation at 1, 3 and 6 months after treatment were higher than that before treatment, but the difference was not statistically significant (x2=1.82, 1.24, 1.69; P＞0.05).ConclusionBCVA and MS are significantly increased in patients with MCNV after intravitreal injection of conbercept.
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.
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.
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.
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.
ObjectiveTo assess the fundus characteristics and their associations with refractive error, best corrected visual acuity (BCVA) of highly myopic eyes in Chinese teenagers. MethodsThis is a cross-sectional and retrospective study. 544 teenagers (1050 eyes) with refraction more than -6.00 D were recruited from Tongren Eye Care Center. All participants underwent examinations including cycloplegic auto-refractometry and retinoscopy, BCVA, slit lamp and 45℃olor funds photography centered in macular. BCVA was recorded with logarithm of the minimum angle of resolution (logMAR) acuity. 988/1050 (94.1%) fundus photographs with clearly visible optic disc and fovea were selected for analysis. Degree of tessellation in optic disc and macular was defined by the exposure of choroidal vessel. Area of beta parapapillary atrophy (PPA), maximal and minimal diameter of optic disc, degree of fundus tessellation were measured by Image J software. Optic disc ovality was calculated by maximal diameter/minimal diameter. Associations between degree of tessellation, beta PPA area, optic disc ovality and refractive error, BCVA were analyzed. Presence of high myopic retinopathy, including chorioretinal atrophy, lacquer crack and Fuchs spot were also observed. ResultsMean spherical equivalent was (-10.66±2.63) D. Mean logMAR BCVA was 0.11±0.22. Tessellation was in 66.9% eyes. Mean degree in macular and peripapillary region was 0.83±0.96 and 1.04±1.00 (r=0.875, P=0.000). Beta PPA was in 97.3% eyes and mean area was (0.45±0.57) mm2. Mean ovality factor was 1.25±0.18 and Tilted optic disc was in 28.5% eyes. Refractive error, logMAR BCVA, beta PPA area, tilted optic disc and ovality factor were related with the degree of optic disc and macular tessellation (P < 0.05). Highly myopic retinopathy was found in 28 eyes, with older age, larger area of PPA, higher presence of tilted optic disc and degree of tessellation, worse BCVA. ConclusionsBeta PPA was the main fundus characteristics in teenagers. Visual acuity can be seriously impaired by highly myopic retinopathy, such as chorioretinal atrophy.
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.
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.