Advances in the efficacy and safety of scleral collagen cross-linking in the prevention and treatment of pathologic myopia / 国际眼科杂志(Guoji Yanke Zazhi)

In 2004, it was the first time that Wollensak and Spoerl had applied physical and chemical cross-linking methods to scleral tissue. They found that the biomechanical strength of cross-linked sclera, induced by riboflavin/ultraviolet A, glyceraldehyde and glutaraldehyde, could be improved and proposed that scleral collagen cross-linking is expected to be a new method for the treatment of pathologic myopia. In recent years, a series of explorations have been made on the effectiveness and adverse reactions of physical and chemical cross-linking in the prevention and treatment of pathologic myopia, including the establishment of various animal models and different myopia modeling methods, the improvement of cross-linking methods, the amelioration of the measurement of biomechanical strength of scleral tissue and the attention of biological parameters such as the thickness of retinal nerve fiber layer and the amplitude of electroretinogram in vivo. Genipin-crosslinking of the scleral collagen combined with posterior scleral contraction/reinforcement has been applied to clinical research. This review summarizes physical cross-linking and the genipin-crosslinking of scleral collagen to explore the effectiveness and safety of the methods in the prevention and treatment of the pathologic myopia.

Intravitreal Conbercept or Ranibizumab for myopic choroidal neovascularization / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the efficacy of intravitreal conbercept or ranibizumab for myopic choroidal neovascularization(CNV).<p>METHODS: A retrospective cohort study. This study included 46 patients(46 eyes)with myopic CNV who were treated with conbercept(conbercept group, 20 cases, 20 eyes)or ranibizumab(ranibizumab group, 26 cases, 26 eyes)from March 2015 to August 2019. Central macular thickness(CMT), the number of injections and complications measured by best-corrected visual acuity(BCVA)and optical coherence tomography(OCT)were compared between the two groups before treatment and 1, 3, 6mo after treatment.<p>RESULTS: Before treatment, the BCVA(LogMAR)of conbercept and ranibizumab groups were 0.81±0.51, 0.83±0.66(<i>P</i>=0.900). After treatment, the BCVA(LogMAR)in the conbercept group at 1, 3 and 6mo were 0.59±0.33, 0.49±0.34, 0.44±0.32, in the ranibizumab group were 0.53±0.54, 0.47±0.47, 0.40±0.43. The BCVA was significantly improved in both groups after treatment(all <i>P</i><0.001). Before treatment, the CMT of conbercept and ranibizumab groups were 242.30±73.27, 233.38±66.63μm(<i>P</i>=0.669). After treatment, the CMT in the conbercept group at 1, 3, and 6mo were 217.00±54.78, 208.65±55.38, 206.00±45.34μm, in the ranibizumab group were 197.42±50.47, 198.38±55.19, 192.15±51.97μm. The CMT was significantly decreased in both groups after treatment(all <i>P</i><0.05). There were no significant differences in the number of injections, BCVA and CMT at each follow-up time points between conbercept and ranibizumab groups(all <i>P</i>>0.05). Systemic adverse reactions and serious ocular complications were not found during the treatment period.<p>CONCLUSION: Intravitreal conbercept or ranibizumab provide similar efficacy to improve the BCVA and reduce the CMT in the patients with myopic CNV. Both conbercept and ranibizumab could be a choice of treatment for myopic CNV.

Research progress of clinical application of posterior scleral reinforcement / 国际眼科杂志(Guoji Yanke Zazhi)

@#Posterior sclera reinforcement(PSR), also known as posterior sclera strengthening or posterior sclera bandage, is a kind of operation to fix biological or non-biological materials to the posterior sclera, with the aim to strengthen sclera and improve the blood circulation of the choroid and retina by using the traction of materials or the immune inflammatory stimulation, thereby delaying the continuous extension of the axis and improving visual function. The main indications of PSR include pathologic myopia(PM)and its related complications. In addition, PSR can also help to improve blood circulation at the posterior pole of the eye in patients with retinitis pigmentosa(RP), especially in conjunction with superficial temporal artery ligation. After more than half a century's development, PSR has been currently considered as one of the few and effective methods to treat PM and RP, but as a more traumatic operation, the stability of its clinical effect varies greatly, so there is still room for improvement in surgical procedures and materials used.

Observation of the macular thickness after the treatment of choroidal neovascularization with pathological myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe and compare the changes of macular retinal thickness in patients with pathologic myopia complicated with choroidal neovascularization ( CNV ) after anti- vascular endothelial growth factor ( VEGF ) therapy or photodynamic therapy ( PDT ) alone, and to explore an effective treatment method for CNV.?METHODS: The clinical data of 43 pathologic myopia patients ( 45 eyes ) complicated with CNV treated in our hospital from November 1, 2014 to June 30, 2015 were retrospectively analyzed and their curative effect of different treatment methods were compared through the analysis. In them, 20 patients (22 eyes) treated with anti-VEGF alone were set as the observation group and 23 patients ( 23 eyes ) treated with PDT were set as the control group. The visual acuity of the two groups after 6mo of treatment was compared, and OCT examination was performed to compare their macular retinal thickness, CNV strong reflection of regional changes and subretinal fluid absorption. The fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were used to compare the CNV leakage and the adverse reactions between the two groups. The width, height, distance from the fovea and the incidence of adverse reactions of the CNV breakthrough retinal pigment epithelium ( RPE ) before and after treatment were compared between the two groups.?RESULTS: The eye ratio of the visual acuity in the observation group increased by two lines was 82％, which was significantly higher than 74％ of the control group, and the difference was statistically significant (P<0. 05);OCT showed no significant difference in retinal thickness before treatment between the two groups (P>0. 05), but after the treatment, the retinal thickness was significantly lower in the observation group than in the control group (P<0. 05). The FFA and ICGA examination showed that the proportion of CNV in the observation group was 86％, and the leakage was reduced by 14％, which was significantly different from that in the control group ( 74％, 22％) , and the difference was statistically significant (P<0. 05). The incidence of adverse reactions in the observation group was 14％ and 17％ in the control group, there was no significant difference between two groups (P>0. 05). After treatment, the width, height and distance from the fovea of the CNV breakthrough RPE of both groups decreased, and the observation group was significantly lower than that of the control group (P<0. 05).?CONCLUSION: Compared with PDT treatment, anti-VEGF treatment alone can significantly improve the visual acuity of patients with pathologic myopia complicated with CNV, reduce macular retinal thickness with a better effect of stopping leakage.

Shapes of posterior sclera and macular in high myopia / 眼科新进展

Objective To observe the types of posterior sclera shape (PSS) and macular shape (MS) in high myopia (HM) and its distributions in the pure HM and pathologic myopia (PM).Methods Together 90 patients with high myopia (163 eyes) in the Third Affiliated Hospital of Nanchang University were included in this study.The medical records from deep range imaging optical coherent tomography (DRIOCT) Atlantis and fundus photography examination were used to analyze the types and distributions of PSS and MS.Then all eyes were grouped into the pure HM group and MP group according to META-PM classification standard for comparing and analyzing the types and distributions of PSS and MS.Results Of all 90 patients (163 eyes),The type Ⅰ,Ⅱ,Ⅲ,ⅨX and Ⅶ PSS was in 44 eyes (27.0％),85 eyes (52.1％),15 eyes (9.2％),15 eyes (9.2％),4 eyes (2.5％),respectively.The type Ⅰ,Ⅱ,Ⅲ,Ⅳ horizontal MS was in 31 eyes (20.3％),23 eyes (15.0％),87 eyes (56.9％),12 eyes (7.8％),respectively.The type Ⅰ,Ⅲ,Ⅳ vertical MS was in 104 eyes (69.8％),28 eyes (18.8％) and 17 eyes (11.4％),respectively.As for horizontal MS combined with vertical MS,type Ⅲ + Ⅰ was in 62 eyes (38.8％),type Ⅰ + Ⅰ in 26 eyes (16.3％),type Ⅲ + Ⅲ in 22 eyes (13.8％),type Ⅱ + Ⅰ in 20 eyes (12.5％),and type Ⅳ + Ⅳ in 10 eyes(6.3％);the others 7 types were in 20 eyes (12.5％).There were statistically significant differences in distribution of PPS and horizontal MS between the pure HM and MP group (x2 =12.67,47.60;P ＜ 0.01).Conclusion Patients with pure high myopia has mainly type Ⅰ,Ⅱ PPS,and type Ⅲ horizontal MS together with type Ⅰ vertical MS plus type Ⅲ + Ⅰ horizontal combined with vertical MS,while type]X PSS and type Ⅳ horizontal MS were commonly seen in PM.

Therapeutic effect of photodynamic therapy and intravitreal injection with ranibizumab for choroidal neovascularization of pathologic myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To investigate the efficacy of photodynamic therapy ( PDT) and intravitreal injection with ranibizumab on macular choroidal neovascularization ( CNV ) of pathologic myopia ( PM) . METHODS: There were patients ( 32 eyes ) who were diagnosed as PM with CNV. Randomly selected 16 cases ( 16 eyes ) which were given the PDT treatment ( PDT group ) . The remaining were given both PDT and intravitreal injection with ranibizumab ( combination group) . There is no significant difference on macular edema between two groups. We analyzed the changes in the best corrected visual activity ( BCVA) , optic coherence tomograph ( OCT ) and fundus fluorescein angiography (FFA) before and 1, 6mo after treatment. RESULTS:One month after the treatment in PDT group:the BCVA increased while the CMT decreased compared with that of pretreatment (P0. 05). One month after treatment: in PDT group, FFA showed no leakage or reduced leakage of CNV in 11 eyes (69%), and the fundus remained leaky in 5 eyes ( 31%); in combination group, FFA showed no leakage or reduced leakage of CNV in 13 eyes (81%);the fundus remained leaky in 3 eyes (19%). Six month after treatment:in PDT group, FFA showed no leakage or reduced leakage in 10 eyes ( 62. 5%); the fundus remained leaky in 4 eyes ( 25%); two eyes ( 12. 5%) relapsed leakage; in combination group, FFA showed no leakage or reduced leakage of CNV in 15 eyes (94%);the fundus remained leaky in 1 eye (6%). CONCLUSlON: Not only PDT but also PDT and intravitreal injection with ranibizumab can block CNV of pathologic myopia completely or partly, and reduce the danger causing descent of vision. Effects and the stability of the combination therapy is superior to PDT treatment.

Application on the thickness of nerve fiber layer of the optic disc in pathologic myopia eyes by OCT / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the application on frequency domain optical coherence tomography ( OCT ) technology of pathologic myopia optic disc neurosensory retinal thickness changes and its relationship with axis oculi, sex and age, and help for the early diagnosis of pathological myopia and primary open angle glaucoma. METHODS:Collected 96 eyes of normal eyes ( axis oculi 23-24mm) and 153 eyes of pathologic myopia eyes ( axis oculi 25-27mm 80 eyes, >27mm 73 eyes). We measured the thickness of nerve fiber layer of the optic disc by OCT and analyzed their relationship with axis oculi, sex and age with multiple linear regression analysis. RESULTS: The observation group showed significant smaller average thickness of peripapillary, superior, inferior, nasal than the control group ( P0. 05); The partial correlation coefficient of peripapillary average thickness of nerve fiber layer and axis oculi was -1. 31, gender was 5. 21, age was -0. 12. CONCLUSION:The thickness of nerve fiber layer of the optic disc in the pathologic myopia eyes are decreased than normal eyes, axis oculi, sex and age are influenced factors. The pathologic myopia patients should use different index combined with optic nerve fiber layer thickness decreased to help for the diagnosis of early primary open angle glaucoma.

The Effect of Pathologic Myopia on the Result of Macular Hole Surgery

PURPOSE: To evaluate if the presence of pathologic myopia could affect the result of macular hole surgery. METHODS: This study was a retrospective comparison of the results of macular hole surgery between a pathologic myopia group (11 eyes) and a non-pathologic myopia group (14 eyes). All patients had undergone PPV, ILM peeling and C3F8 (20%) gas temponade. BCVA, IOP and OCT findings were evaluated preoperatively and at 6 months after surgery. Postoperative BCVA, IOP and macular hole closure were compared between each groups. RESULTS: The only statistically significant preoperative parameter between the groups was axial length (p < 0.001). Postoperative BCVA was lower in the pathologic myopia group, but the difference was not statistically significant. The rate of macular hole closure was statistically significant higher in the non-pathologic myopia group (p < 0.001). CONCLUSIONS: The presence of pathologic myopia may negatively affect the result of macular hole surgery.

Change of serum high sensitive C-reactive protein level in patients with pathologic myopia / 中华实验眼科杂志

Background Pathologic myopia is one of the common blinding eye diseases.Recent research suggests that immune response participates in the pathogenesis of pathologic myopia,and inflammation is an important factor that influent immune status.Objective Present study was to observe the change of high sensitive C-reactive protein(hs-CRP) in serum in the patients with pathologic myopia and explore the role of inflammation in the development of pathologic myopia. Methods Serum hs-CRP was measured from 30 patients with pathologic myopia,30 patients with simple myopia and 30 normal controls with Nephelometric Turbidity in the OLYMPUS AU5400 automatic biochemical analyzer.Written informed consent was obmined from each subject before medical examination.Results The mean age was(30+10) years in pathologic myopia group,and(32+8)years in simple myopia group and(32+9)years in normal control group.The range of preoperative spherical equivalent refraction was (-6.00--22.00) D in pathologic myopia group,(-1.00--6.00) D in simple myopia group and(-1.00-+1.00) D in normal control group.The level of hs-CRP in serum was(3.68±1.15)mmol/L in the patients with pathologic myopia and was significantly higher than that of simple myopia group(1.99±0.68 mmol/L)and normal controls (2.11±O.66 mmol/L)(q=10.69,P＜0.01;q=9.91,P＜0.01),respectively.No significant correlation was found between hs-CRP level and myopic degrees in pathologic myopia group(R2=0.037,P＞0.05). Conclusion Hs-CRP may play rule in the inflammatory reaction during the pathogenesis of pathologic myopia.

Short-term Efficacy of Intravitreal Ranibizumab for Myopic Choroidal Neovascularization

PURPOSE: To evaluate the effects of intravitreal ranibizumab in myopic choroidal neovascularization (CNV). METHODS: Patients who underwent intravitreal ranibizumab injection for myopic CNV, and were followed up more than 6 months, and their records were retrospectively investigated. The best corrected visual acuity, central macular thickness, and leak in fluorescein angiography were compared at baseline, and at 1, 3, and 6 months after injection. RESULTS: Twenty-one eyes of 18 patients were evaluated. The mean best corrected visual acuity (logMAR) was 1.23+/-0.65, 0.96+/- 0.40, 0.95+/-0.67, and 0.83+/-0.58 at baseline, 1, 3, and 6 months, respectively (p<0.001, p=0.006, p=0.001). The mean central macular thickness was 233.42+/-65.55 microm, 204.14+/-65.29 micrometer, and 157.76+/-71.45 microm at baseline, 3, and 6 months, respectively (p<0.001). In fluorescein angiography at 6 months after injection, regression was observed in 12 eyes, and fibrosis in 9 eyes. CONCLUSIONS: Intravitreal ranibizumab injection for myopic CNV in Korean patients appeared to be effective, resulting in regression of lesion and improvement of visual acuity.

Characteristics of choroidal neovascularization secondary to pathologic myopia and anti-VEGF therapy / 上海交通大学学报（医学版）

Choroidal neovascularization is one of the common causes resulting in vision loss in patients with pathologic myopia, and the irreversible central vision lose is often found. This article reviews the epidemiology of pathologic myopia, pathogenesis, clinical manifestation and anti-VEGF therapy of choroidal neovascularization secondary to pathologic myopia.

The clinical spectrum of localized peripapillary detachment in pathologic myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To report the clinical manifestations of localized peripapillary detachment in pathologic myopia and to evaluate its underlying associations and causes.METHODS: From December 2002 to January 2004, 10eyes from 7 patients with high myopia were identified to have localized peripapillary detachment by optical coherent tomography (OCT). The features were described together with the fundus fluorescein angiography, indocyanine green angiography and multifocal electroretinogram.RESULTS: Localised peripapillary detachments did not cause any symptoms by themselves and all the lesions were recognized because of other ocular problems. The areas of peripapillary detachment were all located within the posterior staphyloma. In the 5 eyes with type 1 staphyloma, the locations of detachment were all in the nasal half of the peripapillary area. In the other 5 eyes with type 2 and 3 staphyloma, the locations of detachment were all in the non-nasal peripapillary area. The difference between these two groups was statistically significant (Fisher's exact test, ,P= 0.01).CONCLUSION: Peripapillary detachment is probably a benign complication of posterior staphyloma in pathologic myopia. The site of peripapillary detachment is affected by the location of staphyloma and OCT is important in making the diagnosis.

Treatment of choroidal neovascularization of pathologic myopia / 上海第二医科大学学报

The fundus lesions appear in early pathological myopia and develops step by step,causing significant visual impairment.The occurrence of choroidal neovascularization is the main cause for the vision loss.This paper gives an introduction to the prevalence,damages,outcomes,affecting factors and treatment for pathologic myopia,and lays emphasis on the progress of medical treatment with anti-vascular endothelium growth factor.

Photodynamic Therapy in Practice: A Review of Experiences with Myopic CNV in Korean Patients

PURPOSE: To evaluate the effects of photodynamic therapy with verteporfin on visual acuity and fluorescein angiography in choroidal neovascularization (CNV) associated with pathologic myopia and to determine if this treatment could reproduce the results achieved in the Verteporfin in Photodynamic Therapy (VIP) Trial in Korean patients. METHODS: Forty-two eyes of 39 patients with CNV secondary to pathologic myopia were included. A retrospective review of their clinical records and fluorescein angiography was done. The patients underwent photodynamic therapy with verteporfin and were followed up for more than 6 months after the therapy. The change in best corrected visual acuity (BCVA) and leakage in fluorescein angiography were evaluated. RESULTS: The mean age of the patients was 39.6 and mean follow-up period was 23.5 months. The BCVA of the patients improved in 22 (52.4%) eyes, was unchanged in 13 (30.9%), and worsened in 7 (16.7%). The leakage in fluorescein angiography decreased in 25 (59.5%) eyes. CONCLUSIONS: Photodynamic therapy with verteporfin for myopic CNV in Korean patients appeared to be effective in stabilization of the lesions and improvement of visual acuity.

Diagnosis and treatment of maculopathies in pathologic myopia / 眼科

With the advent of new diagnostic equipment OCT and treatment modalities PDT as well as refined vitrectomy technique, our capability to manage subfovel CNV and retinal detachment induced by macular hole in high myopic eye is improved. More important is that these developments help us to detect new macular pathology in high myopia, such as posterior retinal detachment without macular hole and foveoschisis, which are unrecognized before. The progresses not only enrich our knowledge but also increase our ability to manage maculopathies in pathologic myopia in recent years.