Long-term development of significant visual field defects in highly myopic eyes.

PURPOSE: To identify the characteristics that are associated significantly with visual field (VF) defects in highly myopic eyes. DESIGN: Retrospective, observational series. METHODS: The medical records of 492 eyes of 308 patients with high myopia (myopic refractive error > 8 diopters or axial length ≥ 26.5 mm) with a follow-up of 5 years or more were reviewed. The VFs were determined by Goldmann kinetic perimetry, and the VFs were quantified in 100 sectors within the V4 isopter. Eyes with loss of 10% or more of the sectors were classified as having significant VF defects, and a further loss of 10% or more during the follow-up period was classified as a significant progression. To avoid the influence of the posterior fundus changes resulting from the high myopia, eyes with any type of myopic macular or peripheral lesions that could cause visual field defects were excluded. RESULTS: Significant VF defects were newly developed in 13.2% of these selected highly myopic eyes during a mean follow-up ± standard deviation of 11.6 ± 5.5 years. The incidence of significant VF defects in myopic eyes was significantly higher in eyes with an oval optic disc than that in eyes with a round optic disc. An oval optic disc was present significantly more frequently in the myopic eyes with VF defects. Temporal and nasal VF defects were present in the same eye. Among the eyes with significant VF defect, the temporal VF defects were observed in 61.5% of the eyes with round discs, in 75.0% of the eyes with vertically oval discs, and in 68.2% of the eyes with obliquely oval discs. During a mean follow-up ± standard deviation of 10.2 ± 3.4 years, 73.8% of the eyes showed a significant progression of the VF defects. An abrupt change of the scleral curvature (types VII and IX staphyloma by Curtin) was the only factor significantly associated with a progression of the VF defects. CONCLUSIONS: Because the VF defects are progressive, we suggest that high myopia is a high risk factor for VF defects and that these eyes be examined at least once yearly. The combination of stretching and distortion of the optic nerve fibers resulting from an abrupt change of scleral curvature may be the factors that lead to the damage of the optic nerve fibers in highly myopic eyes.

Correlation between visual prognosis and fundus autofluorescence and optical coherence tomographic findings in highly myopic eyes with submacular hemorrhage and without choroidal neovascularization.

PURPOSE: To determine whether a significant correlation existed between the visual prognosis and fundus autofluorescence and optical coherence tomographic images in highly myopic eyes with simple macular bleeding. METHODS: We reviewed the charts of 31 eyes of 28 patients with high myopia and simple bleeding. The patients were divided into those whose best-corrected visual acuity (BCVA) was 20/32 and those with BCVA <20/32 at 6 months after absorption of the hemorrhage. RESULTS: At 6 months, 19 eyes had BCVA ≥0.7 and 12 eyes had BCVA <0.7. In the former group, the inner segment/outer segment line of photoreceptors was intact in optical coherence tomographic images at the onset but was defective in 75% of the eyes in the latter group. At 6 months, the inner segment/outer segment defect was absent in all the eyes in the former group but was observed in 67% of the latter group. A hypoautofluorescence was present at the area of the bleeding more frequently in the poor BCVA groups. CONCLUSION: An inner segment/outer segment defect at the onset of simple bleeding might be a useful sign to predict a limited visual recovery. The persistent hypofluorescence in fundus autofluorescence is probably caused by damage to the retinal pigment epithelium by the subretinal hemorrhage.

Long-term changes in axial length in adult eyes with pathologic myopia.

OBJECTIVE: To examine the long-term changes of the axial length in adults with high myopia. DESIGN: Open-label, consecutive, retrospective case series. METHODS: The medical records of 101 patients (184 eyes) with high myopia (myopia ≥-6 diopters or axial length ≥26.5 mm) were studied. The axial length of the eye was measured by A-scan ultrasonography. The significance of the changes in the axial length during follow-up was determined. The effects of the age, axial length, and the presence of a posterior staphyloma at the initial examination on the axial length elongation were determined. RESULTS: The mean follow-up period was 8.2 years. The median axial length increased significantly from 28.6 mm at the initial examination to 29.4 mm at the final examination in the 184 eyes. The axial length remained stable (≤1-mm difference) in 69%, whereas the axial length increased by more than 1 mm in 31% of the eyes. For these 31%, the median axial length increased by 1.55 mm. An increase of the axial length per year was significantly greater in older patients than their younger cohorts, and the increase in eyes with a posterior staphyloma was significantly greater than in eyes without a staphyloma. Multiple regression analyses showed that the axial length elongation was positively and significantly correlated with patient age at the initial examination. CONCLUSIONS: In highly myopic adult patients, the axial length continued to increase. Older individuals with posterior staphyloma were more susceptible to having a larger increase in the axial length. A progression of posterior staphyloma with increasing age is considered a key factor for the continuous increase of axial length in adults with high myopia.

Long-term pattern of progression of myopic maculopathy: a natural history study.

OBJECTIVE: To investigate the long-term progression pattern of myopic maculopathy and to determine the visual prognosis of each progression stage. DESIGN: Retrospective, observational case series. PARTICIPANTS: The medical records of 806 eyes of 429 consecutive patients with high myopia (refractive error more than -8.00 diopters [D] or axial length > or =26.5 mm) who were followed for 5-32 years were reviewed. METHODS: Participants had complete ophthalmological examinations including best-corrected visual acuity, axial length measurements, fluorescein angiography, and color fundus photography, at least once a year. The presence and type of posterior staphyloma was determined by binocular stereoscopic ophthalmoscopy. The types of myopic maculopathy included tessellated fundus, lacquer cracks, diffuse chorioretinal atrophy, patchy chorioretinal atrophy, choroidal neovascularization (CNV), and macular atrophy. None of the patients had received any type of treatment for the maculopathy. MAIN OUTCOME MEASURES: The longitudinal long-term progression pattern and the visual prognosis of each type of fundus lesion. RESULTS: During the mean follow-up of 12.7 years, 327 of the 806 highly myopic eyes (40.6%) showed a progression of the myopic maculopathy. The most commonly observed patterns were from tessellated fundus to the development of diffuse atrophy and lacquer cracks, an increase in the width and progression to patchy atrophy in eyes with lacquer cracks, an enlargement of the diffuse atrophy, and the development of patchy atrophy in eyes with diffuse atrophy, and an enlargement and fusion of patches of atrophic areas in eyes with patchy atrophy. Eyes with tessellated fundus, lacquer cracks, diffuse atrophy and patchy atrophy at the initial examination progressed to the development of CNV. Eyes with CNV developed macular atrophy. The fusion of patchy atrophy, the development of CNV, and macular atrophy all led to significant visual decreases. A posterior staphyloma was observed more frequently in eyes that showed progression from tessellated fundus, diffuse atrophy, and patchy atrophy than those without a progression. CONCLUSIONS: These findings indicate that myopic maculopathy tends to progress in approximately 40% of highly myopic eyes, and the pattern of progression affects the visual prognosis. Preventive therapy targeting posterior staphyloma should be considered to prevent the visual impairment caused by the progression of myopic maculopathy.

Altered function of factor I caused by amyloid beta: implication for pathogenesis of age-related macular degeneration from Drusen.

The results of recent studies have implicated local inflammation and complement activation as the processes involved in the pathogenesis of age-related macular degeneration (AMD). We have demonstrated that amyloid beta (Abeta), which is deposited in drusen, causes an imbalance in the angiogenesis-related factors in retinal pigment epithelial cells. We have also shown that neprilysin gene-disrupted mice accumulate Abeta, and develop several features of AMD. The purpose of this study was to investigate the mechanisms involved in the development of AMD that are triggered by Abeta. Our results showed that Abeta binds to complement factor I which inhibits the ability of factor I to cleave C3b to inactivated iC3b. Factor H and factor I are soluble complement-activation inhibitors, and preincubation of factor I with Abeta in the presence of factor H abolished the ability of Abeta to cleave C3b, and also abolished the ability of factor I to cleave FGR-AMC. In contrast, Abeta did not affect the function of factor H even after binding. The production of iC3b was significantly decreased when C3b and factor H were incubated with the eyes from neprilysin gene-disrupted mice as compared with when C3b and factor H were incubated with eyes from age-matched wild-type mice. These results suggest that Abeta activates the complement system within drusen by blocking the function of factor I leading to a low-grade, chronic inflammation in subretinal tissues. These findings link four factors that have been suggested to be associated with AMD: inflammation, complement activation, Abeta deposition, and drusen.

Connexin 43 contributes to differentiation of retinal pigment epithelial cells via cyclic AMP signaling.

Retinal pigment epithelium (RPE) cells play important roles in the visual system that supports neurosensory retina homeostasis. Connexin (Cx) 43-mediated gap-junctional intercellular communication (GJIC) participates in the regulation of retinal organogenesis, but much of the function of Cx43 on the differentiation of RPE cells is unclear. Here, we report the involvement of Cx43 in RPE differentiation. Knockdown of Cx43 in RPE cells dramatically inhibited the differentiation, whereas Cx43-overexpression successfully induced RPE cell differentiation under de-differentiation conditions. From the experiments using GJIC inhibitors and C-terminus-truncated mutant of Cx43, it was clearly demonstrated that the regulation of RPE cell differentiation by Cx43 did not result from Cx43-mediated GJIC. The RPE cell differentiation induced by Cx43-overexpression was abolished by a cAMP antagonist. In contrast, the treatment with forskolin and phosphodiesterase inhibitor rolipram induced RPE cell differentiation under de-differentiation conditions. These findings indicate that Cx43 contributes to RPE differentiation via cAMP signaling.

Morphology and long-term changes of choroidal vascular structure in highly myopic eyes with and without posterior staphyloma.

PURPOSE: To determine whether the choroidal vasculature is altered in highly myopic eyes with or without posterior staphyloma using indocyanine green angiography. In addition, to analyze long-term changes of the choroidal vasculature in patients who were observed for at least 5 years with indocyanine green angiography. DESIGN: Consecutive, retrospective, observational case series. PARTICIPANTS: Three hundred twenty-one eyes of 195 patients with high myopia. METHODS: Indocyanine green angiograms were analyzed, and the effect of posterior staphyloma on the choroidal vasculature was studied. Changes in the indocyanine green-determined choroidal vasculature detected after at least 5 years were analyzed in 57 eyes of 36 patients. MAIN OUTCOME MEASURES: Indocyanine green angiography assessment of the choroidal vasculature. RESULTS: A choroidal flush was detected in all of the control eyes but only 52 (16.2%) of the 321 highly myopic eyes. A displacement of the entry site of the posterior ciliary arteries into the choroid was observed in 76.6% of the eyes with posterior staphyloma and in 25.3% of the eyes without (P<0.001). There were fewer large choroidal veins in the posterior fundus, and in some cases, there was marked variation in the diameter of neighboring large choroidal veins in the highly myopic patients. Of 57 eyes that were followed for >5 years, 9 (15.8%) showed changes in the choroidal vascular structure in the later indocyanine green angiograms. Four of 9 eyes showed dilation or enlargement of posterior routes of choroidal venous outflow, 5 showed narrowing of the large choroidal veins, and 2 had a loss of the large choroidal veins (overlapped). One patient developed choroidal neovascularization after loss of the large choroidal veins. CONCLUSIONS: These findings indicate that the choroidal vasculature can be significantly altered in highly myopic eyes, and this is more prevalent in eyes with posterior staphyloma. Whether these alterations are related to the development of chorioretinal lesions in highly myopic eyes is now being investigated.

Trans-Tenon's retrobulbar triamcinolone infusion for myopic choroidal neovascularization.

PURPOSE: To report the effects of trans-Tenon's retrobulbar injection of triamcinolone acetonide for subfoveal and juxtafoveal choroidal neovascularization (CNV) caused by pathological myopia. METHODS: Eleven consecutive patients (11 eyes) with myopic CNV were treated with trans-Tenon's retrobulbar injection of triamcinolone acetonide. Each patient received a single injection. Evaluation included best corrected visual acuity (BCVA) measurements, fluorescein fundus angiography, retinal oedema examined by optical coherence tomography (OCT), and retinal sensitivity using scanning laser ophthalmoscopy (SLO) at the initial examination and at 6 and 12 months after treatment. RESULTS: At 6 months after treatment, BCVA had improved by at least two ETDRS lines in eight eyes, and remained unchanged in three eyes. No eye showed worsening of VA by two or more ETDRS lines. At 12 months, BCVA had improved by at least two ETDRS lines in 10 eyes and remained unchanged in only one eye. The size of the CNV decreased in all patients after treatment. Fluorescein fundus angiography revealed an absence of dye leakage in the late angiographic phase. Optical coherence tomography revealed decreased retinal oedema in all patients and SLO microperimetry revealed an increase in retinal sensitivity in seven eyes, at both 6 and 12 months after treatment. Chorioretinal atrophy developed around the CNV in 10 eyes at 6 months and in all eyes at 12 months after treatment. CONCLUSIONS: Trans-Tenon's retrobulbar injection of triamcinolone acetonide for CNV resulting from pathological myopia appears to be relatively safe and to have a good visual outcome, although a longterm follow-up study in a larger series of patients is necessary.

In vitro and in vivo characterization of iris pigment epithelial cells cultured on amniotic membranes.

PURPOSE: To determine whether human amniotic membranes (AMs) can induce human and rat iris pigment epithelial (IPE) cells grown on them to develop characteristics of RPE cells in situ better than IPE cells grown on plastic plates, and to determine whether subretinal transplantation of IPE cell sheets grown on AMs can protect photoreceptor cells in dystrophic Royal College of Surgeons (RCS) rats. METHODS: IPE cells from humans and Long-Evans rats were cultured on the basement membrane side of dispase-treated AMs. Two weeks after seeding, ultrastructural changes were evaluated by transmission electron microscopy, and the level of expression of several genes present in differentiated retinal pigment epithelial (RPE) cells was determined by real time PCR and western blotting. IPE cell sheets cultured on AMs were transplanted into the subretinal space of 4-week-old RCS rats, and eyes were analyzed histologically 12 weeks after grafting. RESULTS: IPE cells cultured on AMs showed ultrastructural features like intercellular junctions, similar to RPE cells in situ. IPE cells grown on AMs had a greater upregulation in the expression of genes important for the function of differentiated RPE cells (e.g., pigment epithelium-derived factor [PEDF], RPE65, bestrophin, VEGF, and BDNF) than IPE cells grown on plastic plates. The number of photoreceptors present in RCS rats after subretinal transplantation of IPE cell sheets grown on AMs was significantly higher than that of sham injected rats and rats receiving transplantation of AMs without IPE cells. CONCLUSIONS: The more advanced degree of differentiation of IPE cells grown on AMs indicates that AMs are a better substrate to culture IPE cells than plastic plates. This was supported by the greater protection of photoreceptors of RCS rats when IPE cell sheets cultured on AMs were transplanted in the subretinal space.

Estimation of visual outcome without treatment in patients with subfoveal choroidal neovascularization in pathologic myopia.

OBJECTIVE: To clarify prognostic factors of long-term visual outcome without treatment in patients with myopic choroidal neovascularization (CNV) and estimate a regression equation to predict visual acuity at 5 years after CNV onset. METHODS: Fifty-four eyes of 54 consecutive patients with high myopia and subfoveal CNV who did not receive treatment were identified using clinical records from 1988 to 2004. Photodynamic therapy not approved for myopic CNV in Japan during this period. The association of best-corrected visual acuity (BCVA) at 5 years after CNV onset with patient age, refractive error, axial length, initial BCVA, myopic retinopathy grade, duration of persistent hemorrhage, CNV size at onset, and size of hemorrhage around the CNV was analyzed using Spearman's correlation and multiple linear regression analysis. RESULTS: BCVA at 5 years after onset was significantly associated with patient age, CNV size, and initial BCVA (P<0.05, Spearman's correlation). The regression equation estimating BCVA at 5 years after CNV onset was based on age and initial BCVA (R2=0.43). When subjects were divided into groups according to age (<40 and >or=40 years), CNV size, axial length and duration of persistent hemorrhage influenced BCVA at 5 years in patients under 40 years; while only initial BCVA was an influence in those at least 40 years old. CONCLUSIONS: We developed a linear predictive model to estimate BCVA at 5 years after onset of myopic CNV without treatment based on the identified prognostic factors. This information might be important for managing patients with myopic CNV.

Characteristics of peripapillary detachment in pathologic myopia.

OBJECTIVE: To evaluate the prevalence and clinical features of a newly recognized peripapillary lesion specific to high myopia, peripapillary detachment in pathologic myopia (PDPM), in a large series of patients with high myopia. METHODS: Three hundred twenty-four patients (632 eyes) with high myopia were enrolled in this study. We examined the prevalence, range, fluorescein and indocyanine green angiographic findings, and optical coherence tomography findings of PDPM for these patients. Visual field testing (Goldmann kinetic perimetry and the Humphrey 30-2 program) was also performed in the patients with PDPM. RESULTS: Peripapillary detachment in pathologic myopia was identified in 31 of 632 highly myopic eyes (4.9%). The optical coherence tomographic scan across the PDPM lesion revealed a localized detachment of retinal pigment epithelium adjacent to the optic nerve. Although PDPM was always situated adjacent to the inferior edge of the optic disc, in some patients it surrounded almost the entire optic disc. There was a steep excavation of the inferior myopic conus adjacent to the PDPM, and the inferotemporal retinal vein was markedly bent at the transition from the PDPM to the excavated myopic conus. Glaucomatous visual field defects were frequently detected in eyes with PDPM (71.0%). CONCLUSIONS: The findings of this study indicate that PDPM is not uncommon among highly myopic eyes. Although its pathogenesis and pathologic significance require further classification, PDPM might be another indicator of visual field defects in high myopia.

Fundus characteristics of high myopia in children.

PURPOSE: To evaluate the fundus characteristics of highly myopic eyes in children. METHODS: We reviewed the medical records of 46 children (1 to 8 years old; mean age, 6.8 years) (80 eyes) with high myopia (4 D or more for children younger than 5 years, 6 D or more for children aged 6-8 years) seen consecutively during a 10-year period at the high-myopia clinic in our hospital. Children of up to 8 years of age at the initial visit were included in the study. RESULTS: Fundus examination revealed posterior staphyloma in only one eye (1.3%) and mild chorioretinal atrophy around the optic disc in 13 eyes (16.3%). There were no patients with choroidal neovascularization or geographic atrophy in the posterior fundus. Myopic peripapillary crescent was observed in 26 eyes (33.8%), but the area of the crescent was relatively small (mean, 0.5 disc area). CONCLUSIONS: The results of the present study showed that myopic fundus changes are uncommon and mild in children. They suggest that aging, in addition to mechanical stretching of the eyeball, might be important for the development of myopic fundus changes.

Retinal pigment epithelium atrophy secondary to dilated choroidal artery in the macula of a highly myopic patient.

BACKGROUND: Indocyanine green angiography revealed a markedly bent and tortuous choroidal artery in the macula of the left fundus in a highly myopic patient. CASE: The patient's corrected visual acuity was 1.0 in both eyes, and he had no visual symptoms. OBSERVATIONS: Ten years after the initial examination, atrophy of the retinal pigment epithelium (RPE) developed above the dilated choroidal artery. CONCLUSIONS: Optical coherence tomography demonstrated that the RPE was stretched above the markedly dilated choroidal artery. Thus, mechanical stretching of the RPE by an abnormally dilated choroidal artery might underlie the development of RPE atrophy.

The effects of amniotic membrane on retinal pigment epithelial cell differentiation.

PURPOSE: To examine the characteristics of retinal pigment epithelial (RPE) cells cultured on amniotic membrane (AM). The present study examined how AM modulates RPE cell differentiation. METHODS: Human RPE cells were cultured on the basement membrane side of dispase treated AM. After one week of cellular confluence, cultures were terminated, conditioned medium was collected, and total RNA was extracted. The expression pattern of several genes considered to participate in the function of differentiated RPE was evaluated. Ultrastructural changes were evaluated by transmission electron microscopy. RESULTS: Morphologically, RPE cells cultured on AM exhibited ultrastructural epithelial features such as microvilli of the apical membrane and intercellular junctions. Gene expression of RPE65, CRALBP, bestrophin, and tyrosinase related protein (TRP)-2 was upregulated in RPE cells cultured on AM compared to cells cultured on plastic. In addition, protein production of vascular endothelial growth factor, thrombospondin-1, and pigment epithelium derived factor was markedly increased in cells cultivated on AM. Gene expression of cathepsin D, brain derived neurotrophic factor, and basic fibroblast growth factor, however, did not differ between RPE cells cultured on plastic or AM. CONCLUSIONS: RPE cells cultured on AM demonstrated an epithelial phenotype morphologically and several growth factors important for maintaining retinal homeostasis were upregulated. AM might be a useful matrix substrate to retain the differentiated and epithelial phenotype of RPE for subretinal transplantation.

Characteristics of patients with a favorable natural course of myopic choroidal neovascularization.

OBJECTIVE: To identify the characteristics of patients with myopic choroidal neovascularization (CNV) who had a favorable visual prognosis without treatment. METHODS: We reviewed the medical records of 52 consecutive patients (57 eyes) with myopic CNV who were followed for at least 5 years after the onset of CNV. Clinical characteristics (patient age, CNV size and location, visual acuity at onset, chorioretinal atrophy development around CNV, and degree of myopia) were compared between patients whose visual acuity 5 years after CNV onset was better than 20/40 and those whose visual acuity was worse than 20/200. RESULTS: Among 57 eyes, eight eyes (14.0%; 8 patients) had a final visual acuity better than 20/40. On the other hand, 37 eyes (64.9%; 33 patients) had a final visual acuity worse than 20/200. Statistical analysis revealed that the patients with a good prognosis (final visual acuity better than 20/40) were significantly younger, had significantly smaller CNV, and significantly better initial visual acuity (Mann-Whitney U-test, p<0.05). Juxtafoveal CNV was more frequently observed in patients with a good prognosis than in those with a poor prognosis (Fisher's exact probability test, p<0.05). Only one patient (12.5%) in the good prognosis group developed a very limited area of chorioretinal atrophy around the regressed CNV, while 91.9% of the patients in the poor prognosis group developed chorioretinal atrophy. Refractive status and the axial length measurements did not differ between the two groups. CONCLUSIONS: Some young patients with myopic CNV retain favorable vision over the long term without active treatment. These information might be useful to predict the visual outcome of patients with myopic CNV.

Reduction of retinal blood flow in high myopia.

PURPOSE: To investigate changes in retinal vessel diameter and blood velocity in high myopia using laser Doppler velocimetry. METHODS: Thirty-nine subjects (39 eyes) were enrolled in the study. The subjects were divided into three groups according to their refractive status; 15 eyes (15 patients) with emmetropia (within +/-3.0 diopters), 14 eyes (14 patients) with mild myopia (between -3.0 and -8.0 diopters), and 10 eyes (10 patients) with high myopia (>-8.0 diopters). Patient age was matched between groups. Blood velocity and vessel diameter of the upper or lower temporal retinal artery were measured using laser Doppler velocimetry with an eye-tracking system, and measurements were compared between groups. RESULTS: The average retinal blood flow and vessel diameter in highly myopic eyes were significantly decreased compared with emmetropic eyes or mild myopic eyes (Mann-Whitney U test, p<0.05). Also, there was significant difference regarding retinal blood flow and vessel diameter between eyes with mild myopia and the other groups. In addition, there was no significant difference in blood velocity between the three groups. CONCLUSIONS: Retinal blood flow was decreased in high myopia, mainly due to the narrowing of the retinal vessel diameter. Impaired retinal blood flow might have a role in the development of chorioretinal atrophy in high myopia.

Factors associated with the development of chorioretinal atrophy around choroidal neovascularization in pathologic myopia.

PURPOSE: To examine the influencing factors on the development of chorioretinal atrophy, which is the main cause of long-term visual decrease in myopic choroidal neovascularization (CNV), in a large series of highly myopic patients. METHODS: Sixty-five patients (81 eyes) with myopic CNV were studied retrospectively. The influence of the patient's age, refractive error, axial length, visual acuity at onset of CNV, size of CNV, and grade of myopic retinopathy on the extent of chorioretinal atrophy more than 3 years after CNV onset was investigated by means of multiple linear regression analysis. RESULTS: Seventy-seven of 81 eyes (95.1%) developed chorioretinal atrophy around myopic CNV during the follow-up period. Multiple linear regression revealed that age was the most influencing factor for the development of chorioretinal atrophy in all the subjects. When we divided the subjects into two groups according to their age, however, CNV size was the only factor to influence the development of chorioretinal atrophy in the patients younger than 40 years, whereas age was still the only influencing factor in those older than 40 years. CONCLUSIONS: The factors influencing the development of chorioretinal atrophy differ according to patient age. Local factors, such as CNV size, determine the tendency to develop chorioretinal atrophy in young patients. Systemic factors, such as patient age, play a greater part in older subjects.

Myopic choroidal neovascularization: a 10-year follow-up.

PURPOSE: To clarify the long-term visual outcome of choroidal neovascularization (CNV) in eyes with high myopia in Asian patients. DESIGN: We reviewed the medical records of 25 consecutive patients (27 eyes) with myopic CNV who were followed up for at least 10 years after the onset of CNV. Visual acuity was examined 10 years after CNV onset. INTERVENTION: Demographic and clinical data were obtained from the patients' medical records. MAIN OUTCOME MEASURES: Visual acuity readings during the 10 years after CNV onset. RESULTS: At the onset of CNV, 19 eyes (70.4%) had a visual acuity better than 20/200, and six eyes (22.2%) had a visual acuity better than 20/40. Three years after the onset of CNV, 15 eyes (55.5%) retained a visual acuity of better than 20/200. At 5 and 10 years after the onset, however, visual acuity dropped to 20/200 or less in 24 eyes (88.9%) and in 26 eyes (96.3%), respectively. The logarithm of the minimum angle of resolution (logMAR) visual acuity was significantly worse at 5 and 10 years after onset as compared with that at CNV onset. Chorioretinal atrophy developed around the regressed CNV in 26 eyes (96.3%) at 5 and 10 years after the onset of CNV. CONCLUSIONS: Long-term visual outcome of myopic CNV is extremely poor. The visual acuity of almost all of the patients dropped to 20/200 or less within 5 to 10 years after the onset of CNV, secondary to the development of chorioretinal atrophy around the regressed CNV. These findings indicate that active treatments should be recommended to prevent long-term visual impairment in Asian patients with myopic CNV.

Prevalence and characteristics of foveal retinal detachment without macular hole in high myopia.

PURPOSE: To report the prevalence of foveal retinal detachment without macular hole in a large number of highly myopic eyes using optical coherence tomography (OCT), and to clarify the demographic characteristics associated with foveal retinal detachment in these eyes. DESIGN: A consecutive, prospective, observational case series. METHODS: In 134 eyes of 78 consecutive patients with high myopia (refractive error of -8 diopters or more), we performed complete ophthalmic examinations and studied cross-sectional images of the macula with OCT. The patients were divided into two groups according to the presence (group 1, n = 78 eyes of 45 patients) or absence (group 2, n = 56 eyes of 33 patients) of posterior staphyloma. Slit-lamp examination with a Goldmann three-mirror lens indicated that none of the eyes had a macular hole. RESULTS: In seven of 78 eyes (9.0%) with posterior staphyloma (group 1), OCT revealed foveal retinal detachment. Two of the seven eyes had foveal retinoschisis. Optical coherence tomography revealed no retinal detachment or retinoschisis in any eye without posterior staphyloma (group 2). Visual acuity of the seven eyes with foveal retinal detachment ranged from 20/40 to 20/200. Two of the seven eyes had visual acuity 20/50 or better. No patients complained of recent, progressive visual impairment. All seven eyes with foveal retinal detachment had severe myopic fundus changes (focal chorioretinal atrophy or bare sclera). CONCLUSIONS: In highly myopic eyes with posterior staphyloma, the prevalence of foveal retinal detachment without macular hole was 9.0%. In eyes with this type of retinal detachment, visual acuity varies and foveal retinal detachment tends to be missed on routine examination. Periodic examination using OCT is recommended for highly myopic eyes with severe myopic degenerative changes and posterior staphyloma.

Choroidal vascular lesions identified by ICG angiography in a case of familial amyloidotic polyneuropathy.

BACKGROUND: To describe a patient with familial amyloidotic polyneuropathy (FAP) whose choroidal vascular lesions were demonstrated dynamically with the use of indocyanine green (ICG) angiography. CASE: A 59-year-old man complained of blurred vision due to vitreal amyloidosis in both eyes. Fundus examination after pars plana vitrectomy showed multiple retinal hemorrhages. OBSERVATIONS: ICG angiography performed after vitrectomy clearly delineated multiple sites of hyperfluorescence indicating tissue staining alongside the major choroidal veins in the lower fundus of his left eye. ICG hyperfluorescence was more evident in the late angiographic phase. Fundus examination and fluorescein angiography revealed no abnormal findings at the corresponding sites of ICG dye leakage. CONCLUSIONS: Choroidal vascular lesions in eyes with FAP were demonstrated in vivo using ICG angiography for the first time. ICG angiography may be very beneficial to evaluate occult choroidal involvement in patients with FAP.