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High myopia is the main cause of visual impairment in the world. With the development of society, the myopia rate is increasing year by year. The development of high myopia is closely related to the progressive extension of the eye axis, and a series of fundus changes will inevitably occur with the extension of the eye axis, such as comus, lacquer cracks, choroidal neovascularization, macular choroidal atrophy, retinal detachment, posterior scleral staphyloma, etc. At present, characterized by younger age and high degree, myopia has become the main cause of blindness in China. This paper briefly summarizes the latest research on the morphological changes of the optic disc, macula, retina, choroid and sclera of high myopia, aiming to provide references for the development of intelligent prediction models, clinical diagnosis and further research on the treatment measures in combination with the fundus morphology of high myopia.
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AIM: To observe the multimodal image features of dome-shaped macula(DSM)with subretinal fluid(SRF)in adolescents with high myopia, and investigate its typical features and identification methods.METHODS: This is a retrospective study. A total of 21 adolescent patients(39 eyes)who were diagnosed as DSM in high myopic eyes with SRF in the macula area in our hospital from January 2021 to May 2022 were selected. All patients underwent color fundus photography(CFP), fundus autofluorescence(FAF), spectral-domain optical coherence tomography(SD-OCT), optical coherence tomography angiography(OCTA)and electro oculography(EOG). Among them, 18 patients(36 eyes)underwent fundus fluorescein angiography(FFA), and they were followed-up for 12mo to record the change of the central macular thickness(CMT).RESULTS: Fundus examination showed tessellated retina in affected eyes, and the deposition of granular material could be seen in the fovea of the macular area. SD-OCT showed a dome-like bulge of the whole layer in the macular area, localized detachment of the subfoveal nerve epithelial layer, the medium and high reflection attachment on the inner surface of the outer membrane, and the heterogeneous reflection of the retinal pigment epithelium(RPE)layer. FAF showed a mild “bull's eye sign” change in the macular area. FFA showed granular transmitted fluorescence around the foveal avascular zone. En face of OCTA could see a clear boundary of the neuroepithelial detachment zone. When the tangential line corresponds to the ellipsoid zone-RPE layer, the granular high reflection in different sizes scattered in the neuroepithelial detachment zone could be seen, and no obvious choroidal neovascularization(CNV)was formed. During the follow-up of OCTA, SRF in the macular area can be spontaneously increased or absorbed irregularly. EOG indicates that the ratio of light peak to dark trough(LP/DT, i.e. Arden ratio)was normal, with an Arden ratio>1.55. CMT at 1, 3, 6, 12mo(247.10±13.03, 246.62±12.23, 248.05±14.00, 247.92±11.66 μm)during follow-up period were compared with baseline(246.95±11.46 μm), and the difference was not statistically significant(F=0.144, P=0.965).CONCLUSION: Multimodal imaging is helpful in the clinical diagnosis of DSM with SRF in the macula area in high myopic eyes of adolescents, and plays an important role in the differential diagnosis of the early stage of typical Best disease.
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Purpose: To report the anatomic and visual outcomes following macular buckling in patients affected by pathological myopia?associated foveoschisis (FS) and macular detachment with or without macular hole (MH). Methods: A retrospective interventional consecutive case series wherein 25 highly myopic eyes (mean axial length 28.46 mm; range, 25–33.8 mm) of 24 patients (16 females and 8 males; mean age 54.1 years; range, 35–74 years) presenting with macular detachment associated with a posterior staphyloma (PS), who underwent macular buckling, were evaluated. Patients with absence or reduction in subretinal fluid by more than 90% during the final follow?up along with inversion of contour of staphyloma were considered to have a successful anatomical outcome and those with improvement or maintenance in visual acuity were considered to have a successful functional outcome. The mean duration of follow?up was 11.2 months. Results: At the time of initial presentation, the mean age of the 24 patients was 54.1 ± 10.28 years. Macular detachment along with FS was present in all cases, whereas full?thickness macular hole?related retinal detachment was present in nine cases. Swept?source optical coherence tomography parameters showed reduction of FS with foveal reattachment in all eyes except one at last visit. Mean axial length decreased from 28.5 mm preoperatively (range 26–33.8 mm) to 26.2 mm (range 24–29.3 mm). The mean best?corrected visual acuity changed from 1.16 log MAR to 1.096 Log MAR (P = 0.165). Visual acuity improved in 10 eyes (40%), remained stable in 11 eyes (44%) and decreased in 4 eyes (16%). Conclusion: Macular buckling is a good surgical technique with encouraging anatomic and visual outcomes in patients with myopic macular detachment associated with PS. Highly selective cases of myopic traction maculopathy can have a viable option of macular buckle surgery in stabilizing the retinal tractional changes, and thereby, vision loss.
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@#AIM:To observe the imaging features of optical coherence tomography angiography(OCTA)in the macular hemorrhage of pathologic myopia.METHODS:Designing a retrospective analysis collected clinical data of 100 patients(108 eyes)diagnosed as macular hemorrhage of pathological myopic in Nanjing Medical University Affiliated Eye Hospital from June 2016 to December 2020. All patients underwent refraction, eye axis,fundus photography, spectral-domain optical coherence tomography(SD-OCT), fundus fluorescein angiography(FFA), indocyanine green angiography(ICGA)and OCTA examination. All patients were divided into macular hemorrhage only with lacquer cracks and macular hemorrhage with choroidal neovascularization(CNV). All patients followed-up for more than 3mo by OCTA. RESULTS:There were 40 patients(42 eyes)diagnosed as macular hemorrhage only with lacquer cracks, OCTA showed bleed obscured by choroidal capillaries. After hemorrhage was being absorbed, lacquer cracks showed linear or stellate reflection completely in the choroidal capillary layer. B-scan image showed discontinuous retinal pigment epithelium(RPE), thinner choroid and an increased light. Penetrance into deeper tissues. After all macular hemorrhage only with lacquer cracks were absorbed, follow-up mode of OCTA found that 2 eyes(4.8%)without lacquer cracks, 28 eyes(66.7%)were linear and 12 eyes(28.6%)were stellate under the original hemorrhage. Follow-up mode also showed that 8 eyes of 8 patients(19.0%)relapsed macular hemorrhage only with lacquer cracks, and 4 eyes of 4 patients(9.5%)suffered secondary macular hemorrhage with CNV. There were 60 patients(66 eyes)diagnosed as macular hemorrhage with CNV,OCTA showed bleed obscured choroidal capillaries, the outer retinal and choroidal capillary layer also showed the shape of CNV around hemorrhage. B-scan showed CNV breaked through the RPE layer and blood flow signal in it. The area of CNV decreased after anti-vascular endothelial growth factor(VEGF)intravitreal injection treatment. Around all macular hemorrhage with CNV, OCTA found that 48 eyes(72.7%)had lacquer cracks, 28 eyes(42.4%)were linear and 20 eyes(30.3%)were stellate.CONCLUSION:OCTA has a great significance in the diagnosis of macular hemorrhage of pathological myopia, fast and non-invasive is the biggest advantage. Choroidal capillary layer can clearly observe the shape and location of hemorrhage,lacquer cracks and CNV. The follow-up mode can intuitively comprehend the changes of disease. To some extent, it can replace fundus angiography to directly judge the classification, and time to treat in the clinic.
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Objective:To analyze the imaging etiology of patients having vision loss with pathological myopia.Methods:A cross-sectional study was conducted.The clinical data of 110 cases (138 eyes) who had vision loss with pathological myopia diagnosed in Xiamen Eye Center of Xiamen University from June 1st, 2016 to May 31st, 2017 was collected and analyzed.Fundus photography was used to observe lacquer cracks; spectral domain optical coherence tomography (SD-OCT), fundus fluorescein angiography, indocyanine green angiography and optical coherence tomography angiography (OCTA) were employed to evaluate the choroidal neovascularization (CNV) and punctate inner choroidopathy (PIC). The macular retinoschisis (MRS), macular atrophy, macular hole and epiretinal membranes were assessed by SD-OCT.The proportion and age distribution of different fundus lesions of pathological myopia complicated with vision loss were analyzed.The study protocol was approved by an Ethics Committee of Xiamen Eye Center of Xiamen University (No.XMYKZX-2016-KY-010). Written informed consent was obtained from each patient before study.Results:Among the imaging causes of visual impairment caused by pathological myopia, there were 87 (63.0%) eyes of myopic CNV (MCNV) with the highest proportion, followed by 53 (38.4%) eyes of lacquer cracks, 48 (34.8%) eyes of MRS, 44 (31.9%) eyes of macular atrophy, 42 (30.4%) eyes of epiretinal membranes, 14 (10.1%) eyes of macular lamellar hole, 19 (13.8%) eyes of full-thickness macular hole (FTMH), and 3 (2.2%) eyes of PIC.The average age was (53.00±1.51) years of MCNV, (53.00±1.77) years of lacquer cracks, (58.00±1.64) years of MRS, (57.00±1.76) years of macular atrophy, (59.00±1.48) years of epiretinal membranes, (61.00±3.90) years of macular lamellar hole, (59.00±3.39) years of FTMH with retinal detachment (RD), and (67.00±0.50) years of FTMH without RD.The average age of PIC patients was (31.00±8.50) years, which was significantly smaller than that of the other groups (all at P<0.05). Conclusions:The main cause of visual impairment resulted from pathological myopia is the obvious abnormality of macular structure, and MCNV is the most common type.
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@#A series of fundus changes caused by excessive axial elongation in pathological myopia, especially maculopathy, are the main factors causing vision loss or blindness. In recent years, with the increasing prevalence of high myopia and pathological myopia, people pay more and more attention to the fundus complications of pathological myopia. It has become a big difficult problem to prevent the irreversible vision impairment caused by pathological myopia. The purpose of this review is to discuss the latest progress of fundus characteristics, diagnosis and treatment of maculopathy in pathological myopia from three aspects based on the latest classification of myopic maculopathy, namely ATN classification system, which considers atrophic(A), tractional(T)and neovascular(N)components.
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@#AIM: To discuss the clinical effects of pars plana vitrectomy(PPV)combined with interal limiting membrane peeling(ILMP)for macular hole(MH)in pathological myopic eyes.<p>METHODS: This is a retrospective case study. Eighteen patients(19 eyes)with high myopic MH diagnosed in our hospital from January 2017 to January 2019 were enrolled in this study. All eyes were grouped for pathological myopia(9 patients 10 eyes)and non-pathological myopia groups(9 patients 9 eyes). All eyes were treated with PPV combined with ILMP surgery. Postoperative follow up was 3-23mo, the efficacy was determined at the final follow up, including BCVA, visual deformation symptoms and macular hole closure.<p>RESULTS: During the final follow up, BCVA was improved in 6 eyes,stable in 2 eyes, more severe in 2 eyes in pathological myopia group, and MH was fully closed in 7 eyes(70%), bareness-closed in 2 eyes(20%)and not closed in 1 eye(10%). In non-pathological myopia group, BCVA was improved in 6 eyes,stable in 2 eyes, more severe in 1 eyes, and MH was fully closed in 8 eyes(88%), not closed in 1 eye(11%). There were significant differences in the axial length between the two groups before surgery, axial length was negatively correlated with the macular hole closure rate at the last follow up(<i>rs</i>= -0.477, <i>P</i>=0.039).<p>CONCLUSION: PPV combined with ILMP for the treatment of MH in high myopia can effectively improve BCVA. However, the hiatal closure rate of pathological myopia patients was lower than that of non-pathological myopia patients.
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@#AIM: To evaluate the one-year outcome of intravitreal conbercept injections for the treatment of choroidal neovascularization secondary to pathological myopia(pm-CNV)by optical coherence tomography angiography(OCTA).<p>METHODS: The medical records of 26 consecutive eyes of 23 patients who received intravitreal injections of conbercept for pm-CNV with a follow-up of 1y were retrospectively reviewed. All the patients were diagnosed by fundus fluorescein angiography(FFA)and OCTA at the first visit. All approaches were performed as “1+PRN” treatment. Outcomes included best-corrected visual acuity(BCVA), central foveal thickness(CFT)and the mean CNV area by OCTA.<p>RESULTS: Mean BCVA improved from(0.66±0.51)at baseline to(0.39±0.38)at 1y(<i>t</i>=3.528, <i>P</i>=0.004). The CFT before treatment and after 1y after were(275.08±48.74)μm and(205.15±43.74)μm respectively(<i>t</i>=4.630, <i>P</i>=0.001). The mean pm-CNV areas before treatment and after 1y treatment were(0.48±0.24)mm<sup>2</sup> and(0.15±0.11)mm<sup>2</sup> respectively, with a significant difference among them(<i>t</i>=5.329, <i>P</i>=0.000). Twenty-one eyes had no needs after the first treatment. Four eyes received 2 injections and only one eye received 3 injections. No severe adverse events were noted relevant to the therapy.<p>CONCLUSION: Intravitreal conbercept can improve the vision and relieve CFT and CNV area for the treatment of pm-CNV with “1+PRN” by OCTA for 1y, however, long-term follow-up still need to be performed.
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@#AIM:To evaluate the clinical effect of the auxiliary application of posterior scleral reinforcement(PSR)in the vitrectomy of macular hole retinal detachment with over-long axial length.<p>METHODS:A clinical randomized controlled trial was conducted. Patients of macular hole retinal detachment with over-long axial length ≥29mm were randomly divided into two groups. Group A accepted PSR + PPV + silicone oil injection, group B accepted PPV + silicone oil injection. After followed-up one year, the BCVA, the percentage of macular hole closure, cure rate of retinal detachment and reoperation rate were analyzed.<p>RESULTS:Totally 46 eyes were included in the study. The average BCVA of the two groups after treatment was improved. The BCVA of group A changed from 1.61±0.02 to 0.85±0.22(<i>t</i>=10.36, <i>P</i><0.01), and that of group B increased from 1.59±0.04 to 1.08±0.16(<i>t</i>=7.92, <i>P</i><0.01). The improvement of group A was greater than that of group B(<i>t</i>= -2.38, <i>P</i>=0.03). There was no significant change of the axial length before and after operation in both groups(<i>P</i>>0.05). In group A, the healing rate of macular hole was 91%(21/23), and the reoperation rate was 4%(1/23)before silicone oil removal. After silicone oil removal, no patients recurred to retinal detachment. During the follow-up period, silicone oil removal was completed in all eyes. In group B, the closure rate of macular hole was 65%(15/23), the rate of reoperation before silicone oil removal was 35%(8/23), the redetachment rate after silicone oil removal was 26%(6/23), and the rate of the silicone oil removal throughout the follow-up period was 74%(17/23).<p>CONCLUSION: PSR can effectively improve the successful rate of pathological myopic macular holes with retinal detachment and reduce the recurrence and reoperation.
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@#AIM: To evaluate the efficacy of formaldehyde release agents(FARs)on scleral cross-linking in living rabbits by measuring the changes in scleral biomechanical properties after the cross-linking.<p>METHODS: Totally 170 healthy New Zealand white rabbits were randomized into 17 groups, including 15 FARs groups(sodium hydroxymethylglycinate, diazolidinyl urea, imidazolidinyl urea, hydantoin and oxazolidine, each of them has three groups based on dosing concentration: 1/10 maximum allowable concentration group, 1/2 maximum allowable concentration group and maximum allowable concentration group), 1 glutaraldehyde(positive control)group and 1 blank control group. Subconjunctivally injected each FAR in the right eye. 60d after the injection, took the sclera at 1:00 and 7:00 sites of the right eye to make scleral strips. The scleral strip's thickness, elastic modulus, creep rate, ultimate stress and ultimate strain were measured to calculate the scleral biomechanical strength.<p>RESULTS: Sodium hydroxymethylglycinate, diazolidinyl urea, imidazolidinyl urea, hydantoin and oxazolidine increased the scleral biomechanical strength in a concentration-dependent manner. In these drugs, sodium hydroxymethylglycinate, diazolidinyl urea and oxazolidine had strong cross-linking effects, with obvious effects at the 1/10 maximum allowable concentration.<p>CONCLUSION: Sodium hydroxymethylglycinate, diazoimidazolidinyl urea, and oxazolidine have strong effects on sclera collagen cross-linking, can significantly improve the biomechanical strength of posterior sclera and have the potential to treat pathological myopia.
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@#The choroidal neovascularization(CNV)secondary to pathological myopia is a common cause of irreversible central vision loss, with high incidence and serious impact on the quality of life of the patients. The traditional therapeutic modalities for CNV secondary to pathologic myopia include thermal laser photocoagulation, transpupillary thermotherapy, and photodynamic therapy with verteporfin. However, the long-term outcome of these treatments are disappointing. Recently, the intravitreal injection of anti- vascular endothelial growth factor(VEGF)treatment can improve the visual acuity and reduce the central retina thickness more effectively than the traditional method. Therefore, these anti-VEGF agents may become first-line drugs for the treatment of CNV secondary to pathological myopia. This review is aim to discuss the pathogenesis of myopic CNV, the molecular structure and mechanism of anti-VEGF drugs, and compare the therapeutic efficacy and safety of anti-VEGF drugs to CNV secondary to pathologic myopia.
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Objective To investigate the efficacy of security and validity of posterior sclera reinforcement (PSR) for high myopic retinopathy (MR).Methods This study included 76 eyes in 41 patients with MR who underwent PSR and were followed up for two years.Preoperative and postoperative axial length,best-corrected visual acuity,the reattachment of retinoschisis and the complications were evaluated.Results The axial length was shortened 3 days,1 month,3 months and 6 months after operation compared with preoperation[(27.71 ± 1.60) mm,(28.11 ± 1.62) mm,(28.58 ± 1.80)mm and (29.01 ± 1.92) mm vs.(30.29 ± 2.01) mm],and the difference was statistically significant (all P =0.000).The axial length gradually increased to preoperative level at 1 year after surgery,and there was no significant difference in the postoperative 2-year and preoperative axial length (P =0.300).The best corrected visual acuity was improved 1 month after surgery,but the improvement had no significantly difference compared with the preoperative one (P =0.080).The best corrected visual acuity was improved at 3 months,6 months,1 year and 2 years postoperatively continuously,and the improvement had significantly difference compared with the preoperative ones (all P ＜0.05).In addition,there were 34 eyes with retinoschisis before surgery,and the retina was completely attached postoperatively in 27 eyes (79.41％),almost attachment was observed in 4 eyes (11.76％),and improvement was in 3 eyes (8.82％).No complications occurred during surgery.Conjunctival irritation,high intraocuiar pressure,orbital inflammation,diplopia and visual deformation and macular bleeding recurrence occurred postoperatively and all recovered in 3 months.Conclusion During 2-year follow-up,it is safe and effective for PSR to treat MR,which can control myopic progression effectively in patients with pathological myopia.
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·AIM: To evaluate the efficacy of anti - vascular endothelial growth factor ( VEGF ) and photodynamic therapy ( PDT) on pathological myopia ( PM) combined with choroidal neovascularization ( CNV ) using ETDRS chart and multifocal electroretinogram (mfERG). ·METHODS: Forty-three patients ( 45 eyes) diagnosed by fundus fluorescein angiography ( FFA ), indocyanine green angiograph ( ICGA ) and optical coherence tomography (OCT) with PM combined with macular CNV were recruited in this study. The patients were randomly divided into two groups for different treatments, intravitreal injection with Ranibizumab ( 20 patients, 22 eyes) and PDT (23 patients, 23 eyes). After treatment, all patients had been followed up monthly for 12mo. The further treatments were operated according to referral situations. The best corrected visual acuity ( BCVA) was recorded with the ETDRS chart and mfERG. At the last follow-up, the therapy efficacy was determined by ETDRS numbers and mfERG and analyzed. ·RESULTS: Before treatment, there was no significant difference on the baseline in ETDRS and mfERG latency of N1 wave, latency and the density values of P1 wave between ranibizumab group and PDT group. After 12mo treatment, the ETDRS number in ranibizumab group (39. 23± 20. 06) significantly increased to the baseline by 5. 88±9. 03(P<0. 05), and in PDT group (37. 38±16. 95) was not significantly improved by 0. 33±6. 94(P>0. 05). There was no significant difference in latency of N1 wave, latency and the density values of P1 wave from treatment response of mfERG in the two groups (P>0. 05). · CONCLUSION: In the treatment of macular CNV complicated by the PM, ranibizumab injection can improve visual function better than PDT, while similar on macular.
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·AIM: To evaluate the efficacy of anti - vascular endothelial growth factor (VEGF) and photodynamic therapy (PDT) on pathological myopia (PM) combined with choroidal neovascularization (CNV). ·METHODS: Forty-three patients (45 eyes) diagnosed by fundus fluorescein angiography (FFA), indocyanine green angiography ( ICGA ) and optical coherence tomography (OCT) with PM combined with macular CNV were recruited in this study. The patients were randomly divided into two groups for different treatments, intravitreal injection with Ranibizumab (20 patients, 22 eyes) and PDT(23 patients,23 eyes). After treatment,all patients had been followed up monthly for 12mo. The further treatments were operated according to referral situations. The best corrected visual acuity (BCVA) was recorded with the ETDRS chart and the mean defect(MD) of the center 10° visual field was measured. At the last follow-up,the therapy efficacy was determined by ETDRS numbers and MD and analyzed. ·RESULTS: Before treatment, there was no significant difference on the baseline in ETDRS and MD between ranibizumab group and PDT group (P>0.05). After 12mo treatment, the ETDRS number in ranibizumab group (39.23±20.06) significantly increased (by 5.88 ± 9.03, P<0.05), but the PDT group (37. 38 ± 16. 95) was not significantly improved(by 0.33±6.94,P>0.05). The MD in ranibizumab group decreased significantly (P<0.05), and no significant change was found in PDT group(P>0.05). · CONCLUSION: In the treatment of macular CNV complicated by the PM, ranibizumab injection can improve visual function better than PDT.
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Objetivo: Exponer la experiencia local sobre el tratamiento de las enfermedades retinales con terapias anti factor de crecimiento endotelial vascular (anti-VEGF) y crear conciencia en relación con la atención centrada en el paciente reconociendo el papel de los médicos especialistas en la determinación del tratamiento más apropiado basado principalmente en la evidencia científica, pero también teniendo en cuenta la experiencia y práctica exitosas en el manejo de cada paciente, con base en sus características únicas e individuales. Método: Revisión y comparación de la literatura científica con la experiencia de los autores, en el diagnóstico y tratamiento de las enfermedades que involucran inyecciones intraoculares, haciendo especial énfasis en la degeneración macular relacionada con la edad neo vascular (DMRE-NV), el edema macular diabético (EMD), la retinopatía diabética (RD), edema macular por oclusión venosa de rama de vena central de la retina (ORVR), la oclusión de vena central de la retina (OVCR) y la neo vascularización sub retiniana asociada a miopía patológica (MP). Resultados: la revisión realizada reafirma que tanto cuando hablamos de clases de medicamentos, de algoritmos de tratamiento o de perfiles de paciente, los diferentes agentes de una misma clase terapéutica pueden tener eficacias o perfiles de seguridad variables. Se debe considerar la importancia clínica que representa la valoración adecuada de los resultados pos tratamiento, pero sobre todo, la selección cuidadosa para determinar el agente y esquema más apropiado en la intención de tratar a un paciente. Si bien existen recomendaciones y guías de tratamiento para las patologías, los protocolos en el manejo individualizado y la exposición de estas experiencias de vida real se hacen necesarios, ya que no todos los pacientes ni todas las enfermedades de la retina responden de igual forma a cada agente terapéutico. Conclusión: La efi cacia y seguridad en el uso de las terapias anti-VEGF son aspectos de suma importancia cuando se trata de proporcionar una atención verdaderamente centrada en el paciente. No hay ninguna solución, intervención o alternativa terapéutica que se ajuste a todas las enfermedades oculares complejas, por lo que es importante hacer un balance que considere la evidencia disponible, la experiencia, y las expectativas de los pacientes y tratantes. Esto permitirá acceder a las alternativas terapéuticas adecuadas, en el momento adecuado siempre teniendo en mente los perfiles de eficacia, seguridad, farmacovigilancia activa y los costos asociados a las alternativas terapéuticas utilizadas en el país.
Purpose: To display local experience on treatment for retinal diseases with anti-Vascular Endothelial Growth Factor (anti-VEGF) therapies and to raise awareness regarding patient-centered care, recognizing the role of medical specialists in determining the most appropriate treatment mainly based on scientific evidence, but also considering the successful experience and practice handling each patient, based on their unique and individual characteristics. Method: Review and comparison of scientific literature according to the authors experience to diagnose and treat diseases involving intraocular injections, focusing on Neovascular Age-related Macular Degeneration (NV-AMD), Diabetic Macular Edema (DME), Diabetic Retinopathy (DR), Macular Edema due to Branch Retinal Vein Occlusion (BRVO), Central Retinal Vein Occlusion (CRVO) and Sub-retinal Neovascularization associated with Pathological Myopia (PM). Results: the review confi rms that, when speaking of drug classes, treatment algorithms or patient profi les, diff erent agents of the same therapeutic class can result in variable efficacies or safety profiles. The clinical relevance represented by the adequate assessment of post-treatment results must be considered, but specially, the careful screening to determine the most appropriate agent and regimen in the intention-to-treat a patient. Th ough recommendations and treatment guidelines for pathologies exist, protocols in individualized management and exposure of these real-life experiences are necessary, since not all patients or all retinal diseases respond in the same way to each therapeutic agent. Conclusion: Efficacy and safety using anti-VEGF therapies are extremely important when it comes to providing truly patient-centered care. There is no therapeutic solution, intervention or alternative that fi ts all complex ocular diseases, so it is important to weigh the available evidence, the experience and the expectations of both patients and prescribers. Th is will allow to get access to the appropriate therapeutic alternatives, in a timely manner, always considering the efficacy and safety profiles, active pharmacovigilance and the costs associated with the therapeutic alternatives used locally.
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Retinal Diseases/therapy , Education of Visually Disabled , Eye Diseases/therapy , Injections, Intraocular , Vascular Endothelial Growth Factor A/therapeutic useABSTRACT
Objective· To investigate the relationship between pathological myopia and classification of vitreoretinal interface features using enhanced vitreous imaging optical coherence tomography (EVI-OCT). Methods · High myopia patients were included from 2015 to 2016. All participants underwent standardized medical interviews and ophthalmic examination. Results · The included eyes were divided into two groups of pathological myopia and simple high myopia based on myopic macular degeneration observed on fundus photography . There were four types of vitreoretinal interface changes demonstrated on EVI-OCT scans in included eyes: Type1, posterior precortical vitreous pockets (PPVP), Type2, partial posterior vitreous detachment with vitreous adhesion (VA), Type 3, epiretinal membrane (ERM), and Type 4, no traction (NT). Pathological myopia was mostly detected in VA, ERM, and NT groups. Conclusion · EVI-OCT was able to demonstrate the early changes of vitreoretinal interface in high myopia eyes. Vitreous adhesions and traction detected by OCT may facilitate the occurrence of pathological myopia.
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AIM: To analyze the effect of compound xuesaitong combined with conbercept on central macular retinal thickness (CMT), fluorescein fundus angiography and best corrected visual acuity(BCVA) in pathological patients with choroidal neovascularization (CNV).METHODS:A total of 60 cases (60 eyes) with pathological myopia and CNV who were admitted to our hospital during January to October 2016 were enrolled in the study.They were divided into observation group and control group, 30 cases in each group.Observation group was treated with compound xuesaitong combined with conbercept.Control group was treated with conbercept only.Changes of CMT, intraocular pressure (IOP), area of CNV, BCVA and serum vascular endothelial growth factor (VEGF) before surgery, 4 and 12wk after surgery were compared.Complications during follow-up were statistically analyzed.RESULTS: At 12wk after surgery, the total effective rate was 97% in observation group, 80% in control group and the difference was significant (P<0.01).The CMT, IOP, area of CNV and serum VEGF levels were significantly lower or smaller than those before surgery while BCVA was significantly higher than that before surgery (P<0.01).There were no local complications of systematic severe complications.CONCLUSION: Compound xuesaitong combined with conbercept can effectively reduce CMT and IOP, reduce the area of CNV and significantly improve visual acuity.Its anti-VEGF effect is obvious, safe and feasible.
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Retinal detachment is one of the common complications of pathological myopia due to presence of retinal break. However, retinal break commonly occurs in the peripheral retina. This case report illustrates the rare incidence of retinal break adjacent to the optic disc, highlights the possible causes of poor visual outcome following surgical repair as well as the possible measures to treat the complications.
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VitrectomyABSTRACT
?Pathological myopia are often complicated by a series of pathological changes in fundus including foveoschisis, which can lead to visual dysfunction when processing with retinal detachment, macular hole, epiretinal membrane and vitreoretinal traction diseases. According to the current knowledge, the main mechanism of foveoschisisi might be attributed to the impaired macular structure and function caused by a variety of traction on the retinal and retina poor condition. Surgical treatments have been reported to be effective in treating foveoschisis, however, the indications and surgical procedures are still controversial. ln this article, we reviewed the clinical features, diagnosis, treatment strategies and prognosis of pathological myopia foveoschisis.