ABSTRACT
Background Myopic maculopathy leads to visual function damage.Conventional methods for the identification of choroidal neovascularization (CNV) of myopic maculopathy are fundus fluorescine angiography (FFA) and spectral-domain OCT (SD-OCT),but FFA is an invasive process and SD-OCT is incapable to image CNV well.OCT angiography (OCTA),a novel and non-invasive vascular technique,appears to be dominant in enface imaging of CNV,however,its clinical value remains to be evaluated.Objective This study was to evaluate the application of OCTA in imaging CNV of myopic maculopathy.Methods A prospective serial cases-observational study was performed.Forty-two eyes of 40 patients of myopic maculopathy were included in Ophthalmic Center,Renmin Hospital of Wuhan University from January to October 2015,with the diopter (-10.5 ± 3.74) D.Comperehensive optical and imaginal examinations were carried out in all the eyes,including fundus photography,FFA,SD-OCT and OCTA.Ranibizumab (0.5 mg/0.05 ml) was intravitreally injected in 35 eyes of 35 patients under the informed consent and SD-OCT and OCTA were examined 1 day,1 week and subsequent each month after injection.FFA was examined 1 month after injection.The patients were followed-up for 1-6 months to evaluate the clinical values of OCTA in monitoring the CNV of myopic maculopathy.This study followed the Helsinki Declaration and was approved by the Ethics Committee of Renmin Hospital of Wuhan University.Written informed consent was obtained from each patient prior to any medical examination.Results All the affected eyes showed dye leakage in CNV lesions by FFA and high reflection signal of abnormal choroidal vascular network throughout retinal pigment epithelium by SD-OCT.Clusters of high signal CNV image was clearly visible in the lesions by OCTA,and these signals were able to be displayed on both choriocapillary layer and outer layer of retina more clearly than FFA in 31 eyes of 31 patients.In 35 eyes of 35 patients received intravitreal injection of ranibizumab,CNV images on both choriocapillary layer and outer layer of retina from OCTA shrinked 1 week after injection and the lesions were stable 1 month after injection.Conclusions OCTA can display CNV of myopic maculopathy on the retinal outer layer and choriocapillary layer more clearly than FFA.Significant changes in the CNV net can be observed by OCTA 1 week after intravitreal injection of ranibizumab.OCTA plays an important role during the following-up of CNV therapy.
ABSTRACT
Myopic foveoschisis is a disease caused by abnormal vitreoretinal interface status and progressive posterior scleral staphyloma.Its occurrence and development are associated with centripetal traction (posterior vitreous cortex,internal limiting membrane and stiff retinal vessel)and centrifugal traction (increasing axial lengths and posterior scleral staphyloma).Currently vitrectomy is the major option to treat this condition as it can alleviate or eliminate centripetal and centrifugal traction.However as myopic foveoschisis is a life-long progressive degenerative disease,often with abnormalities in retinal pigment epithelium,choroid and sclera;the therapeutic effect of current surgical strategy (vitrectomy or scleral surgery,or combined surgery)is limited and unsatisfactory.A full assessment macular structure,function and related factors before surgery is helpful to predict the anatomical and functional prognosis.
ABSTRACT
Objective The 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.Methods This was a retrospective study.The clinical data of 1 5 patients (1 5 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 C3 F8 tamponade were performed.Results The 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 ⅡCurtin 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).Conclusions The clinical characteristic of our series of patients were as follows:long history,with choroidal detachment and type ⅡCurtin posterior scleral staphyloma.All 1 5 eyes showed retinal attached after secondary ILM peeling.The secondary ILM peeling and C3 F8 tamponade may improve the visual outcome and retinal reattachment rate.