AIM:To investigate the affecting factors of parapapillary gamma and delta zones and other fundus morphological features in high myopia.METHODS:Seventy high myopia patients were included in this retrospective observati...AIM:To investigate the affecting factors of parapapillary gamma and delta zones and other fundus morphological features in high myopia.METHODS:Seventy high myopia patients were included in this retrospective observational study and 47 patients were female.Patients were divided into three groups:no posterior staphyloma(no PS),PS with myopic traction maculopathy(PS with MTM),and PS without MTM using 3-dimensional magnetic resonance imaging and optical coherence tomography.MTM patients were fur ther classified into three types[epiretinal membrane,macular hole,and macular retinoschisis(MRS)].Diameters of the gamma and delta zones were measured among other morphometric variables using fundus photographs.RESULTS:Of the 70 individuals(127 eyes),the mean age was 57.46±13.56y.In univariate analysis,morphological features changed most dramatically in PS with MTM patients,who had the largest gamma zone diameters,the largest disk-fovea distance(DFD)and disk-fovea angle,and the smallest angle kappa and vertical distance of temporal arterial arcade.However,their horizontal delta zone diameter was smaller than in the patients with PS yet without MTM.In multivariate analysis,with axial length(AL)and age adjusted,the horizontal diameter in the delta zone of the PS without MTM group was still significantly larger than in the PS with MTM group(P=0.024).Comparing the three subtypes of MTM patients,the diameters of the gamma zone and DFD in MRS group were the largest.CONCLUSION:The characteristics of the gamma and delta zones change inconsistently in different stages of high myopia.These changes may be associated with anatomical changes caused by local traction.Factors such as PS,AL and age play an important role.These findings may provide a hint about the pathogenesis of traction in high myopia.展开更多
AIM: To observe the clinical effect of pars plana vitrectomy(PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma(PS) marginal retinal photocoagulation in the treatment of hi...AIM: To observe the clinical effect of pars plana vitrectomy(PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma(PS) marginal retinal photocoagulation in the treatment of high myopic macular hole retinal detachment(MHRD) with PS.METHODS: This was a retrospective clinical study. From May 2017 to March 2020, 62 MHRD patients with PS(62 eyes) were enrolled in the study. Patients were divided into 23 G PPV combined with PS marginal retina intraoperative photocoagulation group(combined group) and conventional surgery group(conventional group), with 31 eyes in each. Triamcinolone acetonide and indocyanine green were used to remove the epiretinal membrane and the posterior macular inner limiting membrane(ILM). In the combined group, 2 to 3 rows of retinal photocoagulation were performed on the edge of the PS. The patients were followed up for an average of 8.34±3.21 mo. The first retinal reattachment rate, macular hole closure rate, Duration of silicone oil tamponade, best corrected visual acuity(BCVA) and average number of operations were observed and compared between the two groups.RESULTS: The first retinal reattachment rates of the eyes in the combined group and the conventional group were 96.7%(29/31) and 67.7%(21/31), respectively(χ~2=6.613, P=0.010). The macular hole closure rates in the combined group and the conventional group were 74.2%(23/31) and 67.7%(21/31), respectively(χ~2=0.128, P=0.721). The Duration of silicone oil tamponade of the patients in the combined group was lower than that of the routine group(t=-41.962, P≤0.001). Postoperative log MAR BCVA values of patients in the combined group and the conventional group were 1.27±0.12 and 1.26±0.11, compared with the log MAR BCVA before surgery, each group was improved(t=19.947, t=-19.517, P≤0.001, P≤0.001). There was no significant difference in the log MAR BCVA between the eyes of the two groups(t=-0.394, P=0.695). The average numbers of operations on the eyes in the conventional group and the combined group were 2.39±0.62 and 2.06±0.25 times, the combined group had fewer operations on average(t=-2.705, P=0.009). CONCLUSION: Intraoperative PPV treatment of MHRD with PS combined with PS marginal endolaser photocoagulation can effectively increase the rate of retinal reattachment after the first operation, reduce the number of repeated operations, and reduce the postoperative duration of silicone oil tamponade.展开更多
Background: In highly myopic eyes, myopic foveoschisis (MF), the earliest stage of myopic traction maculopathy (MTM), is present in up to 34% of patients with pathologic myopia and slowly progresses to form foveoretin...Background: In highly myopic eyes, myopic foveoschisis (MF), the earliest stage of myopic traction maculopathy (MTM), is present in up to 34% of patients with pathologic myopia and slowly progresses to form foveoretinal detachment (FRD) or macular hole (MH) with or without macular hole retinal detachment (MHRD) as a part of its natural history. Aim: To describe the microstructural and functional results in three highly myopic eyes that underwent macular surgery for early-stage MTM. The last postoperative structural findings were correlated with the final vision and macular automated microperimetry evaluation. Methods: We retrospectively reviewed three highly myopic eyes that underwent successful fovea-saving internal limiting membrane (FS-ILM) macular surgery for chronic FRD at Oftalmologia Integral ABC, Mexico City, Mexico. We performed postoperative multimodal microstructural and functional evaluations, including SD-OCT, SS-OCT, and microperimetric macular examinations. Results: There was a substantial difference between best-corrected visual acuity (BCVA) preoperatively and postoperatively in all three cases. Postoperative surgery was associated with significant improvement in visual acuity confirmed using a paired-sample permutation test. The mean presurgical BCVA value (LogMAR;mean ± SE) was ~0.83 ± 0.15, and the postsurgical value was ~0.43 ± 0.52 (P = 0.00065). The myopic foveoretinal detachment evaluation was ~7.3 ± 3.5 months, with a mean postoperative follow-up time of ~14 ± 4.08 months. Furthermore, postoperative multimodal imaging tests demonstrated an abnormal microstructural foveal SS-OCT pattern without evidence of macular hole (MH) development at the postoperative follow-up. Macular microperimetry confirmed a subclinical reduced macula threshold sensitivity with an anomalous retinal sensitivity analysis map and a stable central foveal fixation site. Conclusions: Even with the successful microstructural disappearance of myopic macular detachment, the last multidisciplinary functional and structural assessments demonstrated different subclinical macular alterations.展开更多
Pathologic myopia is the major cause of the loss of the best-corrected visual acuity(BCVA)worldwide,especially in East Asian countries.The loss of BCVA is caused by the development of myopic macula patchy,myopic tract...Pathologic myopia is the major cause of the loss of the best-corrected visual acuity(BCVA)worldwide,especially in East Asian countries.The loss of BCVA is caused by the development of myopic macula patchy,myopic traction macula patchy,and myopic optic neuropathy(or glaucoma).The development of such vision-threatening complications is caused by eye deformity,characterized by a formation of posterior staphyloma.The recent advance in ocular imaging has greatly facilitated the clarification of pathologies and pathogenesis of pathological myopia and myopia-related complications.These technologies include ultra-wide field fundus imaging,swept-source optical coherence tomography,and 3D MRI.In addition,the new treatments such as anti-VEGF therapies for myopic choroid all neovascularization have improved the outcome of the patients.Swept-source OCT showed that some of the lesions of myopic maculopathy were not simply chorioretinal atrophy but were Bruch’s membrane holes.Features of myopic traction maculopathy have been analyzed extensively by using OCT.The understanding the pathophysiology of complications of pathologic myopia is considered useful for better management of this blinding eye disease.展开更多
基金Supported by the National Natural Science Foundation of China(No.81870686)Beijing Municipal Natural Science Foundation(No.7184201)Capital’s Funds for Health Improvement and Research(No.2018-1-2021)。
文摘AIM:To investigate the affecting factors of parapapillary gamma and delta zones and other fundus morphological features in high myopia.METHODS:Seventy high myopia patients were included in this retrospective observational study and 47 patients were female.Patients were divided into three groups:no posterior staphyloma(no PS),PS with myopic traction maculopathy(PS with MTM),and PS without MTM using 3-dimensional magnetic resonance imaging and optical coherence tomography.MTM patients were fur ther classified into three types[epiretinal membrane,macular hole,and macular retinoschisis(MRS)].Diameters of the gamma and delta zones were measured among other morphometric variables using fundus photographs.RESULTS:Of the 70 individuals(127 eyes),the mean age was 57.46±13.56y.In univariate analysis,morphological features changed most dramatically in PS with MTM patients,who had the largest gamma zone diameters,the largest disk-fovea distance(DFD)and disk-fovea angle,and the smallest angle kappa and vertical distance of temporal arterial arcade.However,their horizontal delta zone diameter was smaller than in the patients with PS yet without MTM.In multivariate analysis,with axial length(AL)and age adjusted,the horizontal diameter in the delta zone of the PS without MTM group was still significantly larger than in the PS with MTM group(P=0.024).Comparing the three subtypes of MTM patients,the diameters of the gamma zone and DFD in MRS group were the largest.CONCLUSION:The characteristics of the gamma and delta zones change inconsistently in different stages of high myopia.These changes may be associated with anatomical changes caused by local traction.Factors such as PS,AL and age play an important role.These findings may provide a hint about the pathogenesis of traction in high myopia.
基金Supported by the Project of Integrated Traditional Chinese and Western Medicine by Tianjin Municipal Health Commission(No.2021067)。
文摘AIM: To observe the clinical effect of pars plana vitrectomy(PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma(PS) marginal retinal photocoagulation in the treatment of high myopic macular hole retinal detachment(MHRD) with PS.METHODS: This was a retrospective clinical study. From May 2017 to March 2020, 62 MHRD patients with PS(62 eyes) were enrolled in the study. Patients were divided into 23 G PPV combined with PS marginal retina intraoperative photocoagulation group(combined group) and conventional surgery group(conventional group), with 31 eyes in each. Triamcinolone acetonide and indocyanine green were used to remove the epiretinal membrane and the posterior macular inner limiting membrane(ILM). In the combined group, 2 to 3 rows of retinal photocoagulation were performed on the edge of the PS. The patients were followed up for an average of 8.34±3.21 mo. The first retinal reattachment rate, macular hole closure rate, Duration of silicone oil tamponade, best corrected visual acuity(BCVA) and average number of operations were observed and compared between the two groups.RESULTS: The first retinal reattachment rates of the eyes in the combined group and the conventional group were 96.7%(29/31) and 67.7%(21/31), respectively(χ~2=6.613, P=0.010). The macular hole closure rates in the combined group and the conventional group were 74.2%(23/31) and 67.7%(21/31), respectively(χ~2=0.128, P=0.721). The Duration of silicone oil tamponade of the patients in the combined group was lower than that of the routine group(t=-41.962, P≤0.001). Postoperative log MAR BCVA values of patients in the combined group and the conventional group were 1.27±0.12 and 1.26±0.11, compared with the log MAR BCVA before surgery, each group was improved(t=19.947, t=-19.517, P≤0.001, P≤0.001). There was no significant difference in the log MAR BCVA between the eyes of the two groups(t=-0.394, P=0.695). The average numbers of operations on the eyes in the conventional group and the combined group were 2.39±0.62 and 2.06±0.25 times, the combined group had fewer operations on average(t=-2.705, P=0.009). CONCLUSION: Intraoperative PPV treatment of MHRD with PS combined with PS marginal endolaser photocoagulation can effectively increase the rate of retinal reattachment after the first operation, reduce the number of repeated operations, and reduce the postoperative duration of silicone oil tamponade.
文摘Background: In highly myopic eyes, myopic foveoschisis (MF), the earliest stage of myopic traction maculopathy (MTM), is present in up to 34% of patients with pathologic myopia and slowly progresses to form foveoretinal detachment (FRD) or macular hole (MH) with or without macular hole retinal detachment (MHRD) as a part of its natural history. Aim: To describe the microstructural and functional results in three highly myopic eyes that underwent macular surgery for early-stage MTM. The last postoperative structural findings were correlated with the final vision and macular automated microperimetry evaluation. Methods: We retrospectively reviewed three highly myopic eyes that underwent successful fovea-saving internal limiting membrane (FS-ILM) macular surgery for chronic FRD at Oftalmologia Integral ABC, Mexico City, Mexico. We performed postoperative multimodal microstructural and functional evaluations, including SD-OCT, SS-OCT, and microperimetric macular examinations. Results: There was a substantial difference between best-corrected visual acuity (BCVA) preoperatively and postoperatively in all three cases. Postoperative surgery was associated with significant improvement in visual acuity confirmed using a paired-sample permutation test. The mean presurgical BCVA value (LogMAR;mean ± SE) was ~0.83 ± 0.15, and the postsurgical value was ~0.43 ± 0.52 (P = 0.00065). The myopic foveoretinal detachment evaluation was ~7.3 ± 3.5 months, with a mean postoperative follow-up time of ~14 ± 4.08 months. Furthermore, postoperative multimodal imaging tests demonstrated an abnormal microstructural foveal SS-OCT pattern without evidence of macular hole (MH) development at the postoperative follow-up. Macular microperimetry confirmed a subclinical reduced macula threshold sensitivity with an anomalous retinal sensitivity analysis map and a stable central foveal fixation site. Conclusions: Even with the successful microstructural disappearance of myopic macular detachment, the last multidisciplinary functional and structural assessments demonstrated different subclinical macular alterations.
文摘Pathologic myopia is the major cause of the loss of the best-corrected visual acuity(BCVA)worldwide,especially in East Asian countries.The loss of BCVA is caused by the development of myopic macula patchy,myopic traction macula patchy,and myopic optic neuropathy(or glaucoma).The development of such vision-threatening complications is caused by eye deformity,characterized by a formation of posterior staphyloma.The recent advance in ocular imaging has greatly facilitated the clarification of pathologies and pathogenesis of pathological myopia and myopia-related complications.These technologies include ultra-wide field fundus imaging,swept-source optical coherence tomography,and 3D MRI.In addition,the new treatments such as anti-VEGF therapies for myopic choroid all neovascularization have improved the outcome of the patients.Swept-source OCT showed that some of the lesions of myopic maculopathy were not simply chorioretinal atrophy but were Bruch’s membrane holes.Features of myopic traction maculopathy have been analyzed extensively by using OCT.The understanding the pathophysiology of complications of pathologic myopia is considered useful for better management of this blinding eye disease.
