Review of prognostic factors of anti-vascular endothelial growth factor therapy on choroidal neovascularization secondary to pathological myopia / 中华眼底病杂志

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.

Long-term efficacy of pars plana vitrectomy with fovea-sparing internal limiting peeling for macular foveoschisis in pathologic myopic / 中华眼底病杂志

Objective To 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. Methods A 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.Results The 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.Conclusions Pars plana vitrectomy with fovea-sparing internal limiting peeling is effective in the treatment of myopic macular retinoschisis. It can improve BCVA and CFT.

The clinical efficacy of inverted internal limiting membrane flap technique with autologous blood for myopic macular hole / 中华眼底病杂志

Objective@#To observe the clinical efficacy of inverted internal limiting membrane (ILM) flap technique with autologous blood for myopic macular hole.@*Methods@#A retrospective, case-controlled study. Twenty-nine eyes of 29 patients with myopic macular hole who received treatment in Eye Hospital of Wenzhou Medical University from January 2017 to May 2019 were enrolled in this study. There were 5 males(5 eyes) and 24 females (24 eyes), with an average age of 55.28±11.40 years. According to the surgical method, the patients were divided into inverted ILM flap group (12 eyes) and ILM peeling group (17 eyes). All patients underwent BCVA, spectral domain OCT and axial length measurement before surgery. There was no significant difference between the two groups in age, gender, course of disease, hole diameter, BCVA and other baseline data. Follow-up was over 4 months after surgery. The BCVA, macular hole closure and continuity of outer retina after surgery were observed.@*Results@#In ILM peeling group, 11 eyes were closed (64.7%) and 6 eyes were not closed at 3 months after surgery. In ILM flap group, 12 eyes were closed (100.0%). The difference of closure rate between two groups was statistically significant (χ2=5.34, P=0.028). The BCVA of inverted ILM flap group was significantly improved at 1, 3 months after surgery compared with preoperative measurements, and the difference was statistically significant (F=3.813, 4.667; P=0.003, 0.001). The BCVA of ILM peeling group was improved at 1 month after surgery, but the difference was not statistically significant (F=1.556, P=0.139). And the BCVA was significantly improved at 3 month after surgery compared with preoperative measurements, and the difference was statistically significant (F=2.453, P=0.026). But there was no significant difference in BCVA between the two groups at 1 and 3 months after surgery (F=0.647, 0.535; P=0.551, 0.612). There was no significant difference in the recovery of outer structure (ELM and EZ continuity) between the two groups at 3 month after surgery (F=0.008, P=0.631).@*Conclusions@#Inverted ILM flap technique with autologous blood is a safe and effective method to treat myopic macular hole. The closure rate of the hole can be improved significantly.

The clinical efficacy of inverted internal limiting membrane flap technique with autologous blood for myopic macular hole / 中华眼底病杂志

Objective To observe the clinical efficacy of inverted internal limiting membrane (ILM) flap technique with autologous blood for myopic macular hole.Methods A retrospective,case-controlled study.Twenty-nine eyes of 29 patients with myopic macular hole who received treatment in Eye Hospital of Wenzhou Medical University from January 2017 to May 2019 were enrolled in this study.There were 5 males (5 eyes) and 24 females (24 eyes),with an average age of 55.28 ± 11.40 years.According to the surgical method,the patients were divided into inverted ILM flap group (12 eyes) and ILM peeling group (17 eyes).All patients underwent BCVA,spectral domain OCT and axial length measurement before surgery.There was no significant difference between the two groups in age,gender,course of disease,hole diameter,BCVA and other baseline data.Follow-up was over 4 months after surgery.The BCVA,macular hole closure and continuity of outer retina after surgery were observed.Results In ILM peeling group,11 eyes were closed (64.7％) and 6 eyes were not closed at 3 months after surgery.In ILM flap group,12 eyes were closed (100.0％).The difference of closure rate between two groups was statistically significant (x2=5.34,P=0.028).The BCVA of inverted ILM flap group was significantly improved at 1,3 months after surgery compared with preoperative measurements,and the difference was statistically significant (F=3.813,4.667;P=0.003,0.001).The BCVA of ILM peeling group was improved at 1 month after surgery,but the difference was not statistically significant (F=1.556,P=0.139).And the BCVA was significantly improved at 3 month after surgery compared with preoperative measurements,and the difference was statistically significant (F=2.453,P=0.026).But there was no significant difference in BCVA between the two groups at 1 and 3 months after surgery (F=0.647,0.535;P=0.551,0.612).There was no significant difference in the recovery of outer structure (ELM and EZ continuity) between the two groups at 3 month after surgery (F=0.008,P=0.631).Conclusions Inverted ILM flap technique with autologous blood is a safe and effective method to treat myopic macular hole.The closure rate of the hole can be improved significantly.

Evaluation of macular visual function in patients with myopic choroidal neovascularization before and after intravitreal injection of conbercept / 中华眼底病杂志

Objective To evaluate the macular visual function of patients with myopic choroidal neovascularization (MCNV) before and after intravitreal injection of conbercept.Methods A 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.Results During 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).Conclusion BCVA and MS are significantly increased in patients with MCNV after intravitreal injection of conbercept.

The progress pattern and natural courses of myopic macularpathy / 中华眼底病杂志

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.

The efficacy of pars plana vitrectomy with internal limiting membrane peeling and gas tamponade in the treatment of myopic macular retinoschisis / 中华眼底病杂志

Objective To observe the efficacy of pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of myopic macular retinoschisis (MF).Methods This is a retrospective case study.A total of 35 MF patients (36 eyes) were enrolled in this study.There were 5 males (5 eyes) and 30 females (31 eyes),with an average age of (60.13 ± 10.00) years.All patients were examined for best corrected visual acuity (BCVA),diopter,optical coherence tomography (OCT) and axial length.The patients were divided into a MF group (group A,10 eyes),MF with foveal detachment group (group B,12 eyes) and MF with lamellar macular hole group (group C,14 eyes) according to the OCT characteristics.There was no difference of age,gender,spherical equivalent refraction and axial length among 3 groups (F=0.020,0.624,0.009,0.195;P＞0.05).There were significant differences of the minimum resolution angle logarithm (logMAR) BCVA and central fovea thickness (CFT) (F=11.100,41.790;P＜ 0.05).All patients underwent pars plana vitrectomy with ILM peeling and gas tamponade.The follow-up was more than one year.The BCVA and macular structure at the final follow-up were analyzed.The efficacy between 3 forms of MF was compared.Results At the final follow-up,the BCVA was 0.40±0.44 and CFT was (213.35±97.58) μm,which were significantly improved compared with preoperative measurements (t=5.984,5.113;P＜0.001).MF was resolved in 33 eyes.In group A,B and C,the logMAR BCVA were 0.13 ± 0.10,0.73±0.33 and 0.38± 0.52,respectively;CFT was (222.40± 57.16),(212.50 ± 150.45),(206.67 ± 55.97) μm,respectively;MF was resolved in 10,11 and 12 eyes,respectively;complete ellipsoid was observe in 8,2 and 12 eyes.The logMAR BCVA (F=6.750,P=0.003) and the rate of complete ellipsoid (x2=18.590,P＜0.001) in group B was lower than group A and C,the differences were significant.There was no difference of CFT (F=0.068,P=0.935) and the rate of MF resolving (x2=1.558,P=0.459) among the three groups.One eye (1/14) in group C suffered from full layer macular hole.Conclusion Pars plana vitrectomy with ILM peeling and gas tamponade is effective in the treatment of myopic macular retinoschisis.The macular structures and BCVA are worst in eyes with foveal detachment.

Inverted internal limiting membrane flap technique for macular hole retinal detachment of high myopia / 中华眼底病杂志

The reattachment rate,macular hole (MH) closure rate,visual acuity improvement and redetachment 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 redetachment.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.

Understanding the characteristics of myopic choroidal neovascularization to improve its diagnosis and treatment outcome and follow-up strategy / 中华眼底病杂志

Myopic choroidal neovascularization (MCNV) is one of the main reasons of vision loss in working population in Asia,which has brought economical and social-psychological burdens with high incidence in China,The precise pathogenesis of MCNV is unclear.Metamorphosia is the main reported symptom in these patients.The lesions were usually with smaller area,less leakage and relatively slow progression.Currently,intravitreal anti-vascular endothelial growth factor agents are now the established standard of care for MCNV,which was a major breakthrough in the treatment of MCNV achieving visual acuity improvement.Since the natural history,clinical features and therapy response of this disease is significant different from that in choroidal neovascularization secondary to age-related macular degeneration,the ~eatment dosing,frequency,retreatment criteria and the follow-up interval should been considerately.Facing the myopia boom in China,there is a need for the development of a precise definition and a more detailed classification for pathogenic myopia,optimize the outcome assessment and follow-up strategy,which should benefit to the further basically and clinical studies.

The thickness of the retina, choroid and sclera in different posterior sclera shape in high myopia / 中华眼底病杂志

Objective To observe the thickness of the retina,retinal nerve fiber layer (RNFL),choroid and sclera among the difference posterior sclera shape (PSS) in high myopia (HM).Methods Sixty HM patients (96 eyes) were enrolled in this study.There were 18 males (25 eyes) and 42 females (71 eyes).The mean age was (51.32±10.06) years.The mean spherical equivalent was (-14.38±6.31) DS.The mean axial length was (29.49±2.44) mm.The eyes were evaluated from deep range imaging optical coherent tomography (DRI-OCT) Atlantis 3D model,and divided as four groups include PSS-Ⅰ (27 eyes),PSS-Ⅱ (46 eyes),PSS-Ⅲ (11 eyes) and PSS-Ⅸ (12 eyes) according to the Curtin classification method.The thickness of the retina,RNFL,choroid and sclera were measured in the EDTRS Grid area.Results There were statistically significant differences in the thickness of retina of the central,first circle,second circle in the EDTRS Grid area among PSS-Ⅰ,PSS-Ⅱ,PSS-Ⅲ and PSS-Ⅸ groups (F=4.48,5.03,4.98;P＜0.01).There was no statistically significant differences in the thickness of RNFL among four groups (F=0.13,P=0.93).There was no statistically significant differences in the central choroidal thickness (F=0.3 1,P=0.81).There were statistically significant differences in the first circle,second circle choroidal thickness among four groups (F=2.86,2.96;P=0.04,0.04).There was no statistically significant differences in the thickness of sclera under macular fovea among four groups (F=0.80,P=0.49).Conlusions There are changes of thickness of the retina,choroid present in the difference EDTRS Grid area among the difference PSS in HM,and changes in PSS-Ⅸ is most obvious.

Intravitreal injection of bevacizumab or ranibizumab for the treatment of pathological myopia choroidal neovascularization / 中华眼底病杂志

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 HDOCT).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 rag).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 ofbevacizumab or ranibizumab can equally effectively improve the visual acuity and reduce the CMT of PM-CNV patients.

Clinical efficacy of vitrectomy combined with internal limiting membrane tamping on macular hole and retinal detachment in high myopia / 中华眼底病杂志

Objective To evaluate the safety and effectiveness of vitrectomy combined with internal limiting membrane (ILM) tamping on macular hole and retinal detachment (MHRD) in highly myopic eyes.Methods 23 patients (23 eyes) were retrospectively reviewed,who were diagnosed as MHRD through examination of the ocular ftmdus,optic coherence tomography (OCT) and B-mode ultrasonography.There were 5 males (5 eyes) and 18 females (18 eyes).The mean age was (62.35 ± 8.28) years.The mean course of disease was 1.1 months.The logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) was 2.31 ± 0.72.The mean axial length was (28.66 ± 1.99) mm.All patients underwent 23G microincision vitrectomy.After vitreous gel and cortex were gently resected,the ILM around the edges of the macular hole was stained with indocyanine green,and was folded and pushed to fill the macular hole gently.Then silicone oil or C3F8 gas tamponade was applied in 18 eyes and 5 eyes,respectively.The silicone oil was removed after 3 months.The follow-up was 6 months.The BCVA,macular hole closure,retinal anatomical reattachment were retrospectively observed,and were used to evaluate the safety and effectiveness of the surgery.Results At the 6 months after surgery,the logMAR BCVA was improved to 1.13 ± 0.38,the difference was significant (t=l 5.33,P=0.00).The postoperative macular hole closure rate and retinal anatomical reattachment rate were 100％.There were no ocular or systemic adverse events observed in all patients.Conclusion Vitrectomy combined with ILM tamping is an effective and safe treatment for the high myopic eyes with MHRD.

The efficacy of vitrectomy combined with internal limiting membrane peeling to treat high myopia macular hole with macular retinoschisis and it affecting factors / 中华眼底病杂志

Objective To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) for macular hole (MH) and macular retinoschisis in high myopic eyes,and to analyze factors affecting the MH closure rate.Methods This is a retrospective case study.21 high myopic patients (22 eyes) with MH and macular retinoschisis were enrolled in this study.All eyes were examined for best corrected visual acuity (BCVA),intraocular pressure,slit lamp microscope,indirect ophthalmoscope,A and/or B-scan ultrasound,optical coherence tomography and visual electrophysiological examination.The BCVA was ranged from finger counting to 0.2.The axial length (AL) was ranged from 26.00 to 31.00 mm,with an average of 27.47 mm.Among 22 eyes,AL was between 26.00 mm to 27.00 mm in 9 eyes,27.10 mm to 28.00 mm in 5 eyes,28.10 mm to 29.00 mm in 3 eyes,29.10 mm to 30.00 mm in 3 eyes,and longer than 30.00 mm in 2 eyes.The diameter of MH was ranged from 227 μm to 597 μm and with an average of 432 μm.Among them,the minimum diameter was between 200 μm to 400 μm in 4 eyes,401 μm to 450 μm in 13 eyes,451 μm to 500 μm in 3 eyes,501 μm to 600 μm in 2 eyes.All the eyes were treated with PPV combined with ILMP surgery.The average follow-up time was 17 months after surgery.The efficacy was determined at the final follow up,including the MH closure,the state of macular retinoschisis and the BCVA.MH closure rate with different MH diameters and different AL were compared and analyzed.Results During the final followup,MH were fully closed in 17 eyes (77.3％),bridge-closed in 4 eyes (18.2％) and not closed in 1 eye (4.5％).Retinoschisis was resolved in 19 eyes (86.4％),partially resolved in 2 eyes (9.1％) and not changed in 1 eye (4.4％).MH with smaller diameter had higher MH closure rate (x2=12.036,P=0.032).MH with longer AL had lower MH closure rate (x2=16.095,P=0.003).The final BCVA was ranged from finger counting to 0.25.Among 22 eyes,BCVA or metamorphopsia were improved in 9 eyes (40.9％),stable in 8 eyes (36.4％).BCVA was reduced and metamorphopsia was more severe in 5 eyes (22.7％).Conclusions PPV combined with ILMP is a safe and effective surgical treatment for MH (with minimum diameter ≤600 μm) and macular retinoschisis in high myopic eyes.After surgery,MH was closed and retinoschisis was resolved in most patients.The major factors affect the MH closure were the minimum diameter of MH and AL.

Clinical observation of vitrectomy combined with internal limiting membrane peeling and scleral shortening for myopic foveoschisis / 中华眼底病杂志

Objective To observe the efficacy ofvitrectomy combined with internal limiting membrane (ILM) peeling and scleral shortening for myopic foveoschisis (MF).Methods Prospective and non-randomized concurrent control study.A total of 35 MF patients (35 eyes) were enrolled in this study.The patients were divided into 2 groups according to surgery,including group A (18 eyes) and group B (17 eyes),all received vitrectomy combined with ILM peeling,but group A also received scleral shortening.The best corrective visual acuity (BCVA) examination using the Snellen vision chart was converted to the minimum resolution logarithm (logMAR).Ocular axis length (AL) was measured by Zeiss IOL-Master or A-scan ultrasound (Quantel Medical,France).The maximal value of retinal foveoschisis (MxFT) was measured by frequency-domain optical coherence tomography (Heidelberg,Germany).Multifocal electroretinogram (mfERG) responses were obtained with the RETIscan system (Roland Consult,Gemany).There was no statistically significant difference between the two groups (P＞0.05) in age (t=0.460),AL (t=1.520),diopter (t=0.020),logMAR BCVA (t=-2.280),MxFT (Z=-4.179) and b-wave ERG amplitude (Z=-0.198).The changes of BCVA,AL,MxFT and b wave amplitude were followed-up for 3-12 months.Results At the last follow-up,the height of MF was decreased in 18 eyes of group A,and MF was completely disappeared in 4 eyes.The logMAR BCVA (t=7.272,5.951),MxFT (Z=-3.724,-3.622) and b-wave ERG amplitude (Z=-3.223,-3.243) in both groups A and B were statistically improved (P=0.000,0.000,0.000,0.000,0.001,0.001) compared to pre-operational results.There was significant difference of logMAR BCVA (t=-2.280) and MxFT (Z=-4.179) between the two groups (P=0.029,0.000).But there was no significant difference in the amplitude of b-wave (Z=-0.198,P=0.843).The AL in group A was shortened after surgery,the difference was statistically significant (t=10.017,P=0.000).During the follow-up,there was no ocular hemorrhage,endophthalmitis and other complications.Conclusion PPV combined with ILM peeling and scleral shortening can shorten AL significantly for MF patients,and gain relative normal anatomical structure of the fovea,thus improve the vision.

The efficacy of vitrectomy for myopic traction maculopathy / 中华眼底病杂志

Objective To observe the anatomical and functional changes in patients with different degrees of myopic traction maculopathy (MTM) after vitrectomy.Methods It was a retrospective case series study.Forty-seven consecutive patients (47 eyes) diagnosed with MTM were studied between January 2010 and May 2014.There were 38 females (38 eyes) and 9 male (9 eyes),mean age was (65.13±6.98) years,mean axial length was (29.23±1.77) mm.The eyes was divided into 3 groups according to the macular morphologies on optical coherence tomography (OCT),including macular retinoschisis only group (MRS group,18 eyes),foveal retinal detachment group (FD group,13 eyes) and full-thickness macular hole group (MH group,16 eyes).All the eyes underwent minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA),intraocular pressure,axial length,A or B-ultrasonography,fundus photography,OCT and microperimetry examinations.The average logMAR BCVA of 47 eyes was 1.43±0.52.The center retinal thickness (CRT) of eyes in MRS and FD group was (528.45± 167.61) μm.All the patients underwent pars plana vitrectomy combined with internal limiting membrane peeling.The mean follow-up period was 23.4 months.The changes of logMAR BCVA,microperimetry and macular microstructural were observed.Results At the final follow-up,the logMAR BCVA of 47 eyes was 0.86 ± 0.42,which improved compared with the preoperative vision (t=7.36,P＜ 0.001).The mean CRT of eyes in MRS and FD group was (250.90 ± 91.81) μm,which improved compared with the preoperative CRT (t=8.17,P＜0.001).In MRS group,the retina was attached in 18 eyes.In FD group,the retina was attached in 11 eyes,MH was observed in 2 eyes.In MH group,recurrent retinal detachment was observed in 1 eye.The differences of logMAR BCVA and retinal sensitivity among MRS,FD and MH groups were significant (x2 =6.38,11.08;P=0.030,0.004).Conclusion The macular structural and visual function in MTM eyes with macular retinoschisis only after vitrectomy are better than those in MTM eyes with MH and foveal retinal detachment.

The morphological characteristics and complications treatment of dome-shaped macula in high myopia / 中华眼底病杂志

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.

Intravitreal Conbercept for treatment of choroidal neovascularization secondary to pathologic myopia / 中华眼底病杂志

Objective To evaluate the efficacy of intravitreal injections of conbercept in choroidal neovascularization (CNV) secondary to pathologic myopia (PM).Methods A retrospective case series of 37 eyes of 37 patients affected with CNV secondary to PM treated by intravitreal injections of Conbercept.All the patients were examined with best-corrected visual acuity (BCVA) of Early Treatment Diabetic Retinopathy Study (ETDRS) chart,central macular thickness (CMT) of optical coherence tomography (OCT) at baseline.The initial average letters of ETDRS BCVA was 49.86±8.87,CMT was (306.38±31.01) μm.All eyes were treated with intravitreal Conbercept 0.05 ml (10 mg/ml).Follow up visits were performed monthly after injection.The mean follow-up time was 16.8 months.Injections were repeated according to the situation of BCVA,CMT,subretinal fluid and CNV leakage in follow-up.All eyes received an average of 4.8 injections.BCVA,CMT and ophthalmoscope examination were assessed monthly.The relationship of BCVA improvement and CMT reduction with the data at baseline and number of treatments were analyzed by Spearman Rho correlation respectively.Results During the 1,3,6 and 12 months after treatment,the mean BCVA were all improved with statistically significant difference (t=17.629,P＜0.01).At 12 months,15 eyes (45.9％) had improvement of 15 letters or more,32 eyes (86.5％) had improvement of 5 letters or more,and 1 eye (2.7％) had decreased more than 5 letters.During the 1,3,6 and 12 months after treatment,the mean CMT were all decreased with statistically significant difference (F=43.726,P＜0.01).At 12 months,the retinal fluid of 34 eyes (91.9％) were absorbed completely;33 eyes (89.2％) had angiographic closure at that time.There was no significant relevance between BCVA improvement and sex,age and course of the disease (P＞0.05),but a significant negative correlation was found between the BCVA improvement and BCVA at baseline,injection times (P＜0.05).There was no significant relevance between CMT reduction and sex,age,course of the disease and injection times (P＞0.05),but a significant positive correlation was found between CMT reduction and CMT at baseline (P＜0.05).There were no systemic or ocular serious side effects during the follow up.Conclusions Intravitreal injections of Conbercept showed BCVA improvement and CMT reduction.It appeared to be effective and safe for choroidal neovascularization secondary to pathologic myopia.Intravitreal Conbercept for CNV secondary to PM showed BCVA improvement,CMT reduction and safety.

Choroidal neovascularization secondary to pathologic myopia: a recent update on diagnosis and treatment / 中华眼底病杂志

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.

Objective quantitative assessment of visual quality with a double-pass instrument for myopic foveoschisis patients / 中华眼底病杂志

Objective To objectively quantitative assess the visual quality in patients with myopic foveoschisis (MF) using a double-pass optical quality analysis system (OQASⅡ).Methods Sixty-two subjects participated in this cross-sectional,observational study,who were divided into three groups based on the pathologic conditions including myopic fovcoschisis group (MFG),myopic control group (MCG) and normal control group (NCG).Measurements with OQAS Ⅱ were performed for the modulation transfer function cut off frequency (MTFcut-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).Results The mean values for MTFcut-off,SRand OSIof MFG,MCGand 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.Conclusions The 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.

Disputes revolved about surgeries of macular vitreoretinal interface abnormalities in highly myopic eyes / 中华眼底病杂志

Macular vitreoretinal interface abnormalities in highly myopic eyes are among the most vision-threatening diseases associated with macular retinal schisis and macular holes.To relieve the traction of the posterior vitreous cortex and to recover the anatomy of fovea for good central vision are the keys to successful repair.However,there are many controversial issues in the efficacy of the surgerical procedures including gas injection,scleral buckling and vitrectomy.How to evaluate these different surgeries and to establish standard surgical procedure options for macular vitreoretinal interface abnormalities in highly myopic eyes needs to be explored.