Correlation between high myopia paravascular abnormalities and myopic traction maculopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Li Xuejing , Cai Zhaoyang , Duan Jialiang ,  Shang Qingli

Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China;

Corresponding?author：

Shang Qingli, Email: 447468021@qq.com

Keywords：

Tomography, optical coherence; Myopic tractional maculopathy; Paravascular abnormality; Posterior vitreous detachment; Posterior scleral staphyloma

DOI：

10.3760/cma.j.cn511434-20230721-00315

Video：

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Objective To observe the morphological characteristics of high myopia (HM) paravalvular abnormalities (PVA), and the correlation between different manifestations of PVA and myopic traction maculopathy (MTM) was analyzed. Methods A cross-sectional clinical study. A total of 42 middle-aged and elderly patients with HM and PVA diagnosed by ophthalmology examination in Department of Ophthalmology, The Second Hospital of Hebei Medical University from June to December 2021 were included in the study. There were 24 eyes in 16 males and 48 eyes in 26 females. Age was (56.71±8.10) years old. Diopter was (－13.05±3.10) D. Axial length (AL) was (28.22±1.04) mm. According to the characteristics of ultra-wide-angle optical coherence tomography images, PVA morphology was divided into paravascular microfolds (PM), paravascular cysts (PC) and paravascular lamellar holes (PLH). MTM was divided into T0-T5 grades, of which MTM≥T3 was defined as severe MTM. The state of vitreoretinal junction was observed and the state of posterior vitreous detachment (PVD) was recorded, which divided into complete PVD and partial PVD. Partial PVD was divided into macular fovea adhesions and paravascular adhesions according to the vitreoretinal adhesions. Posterior scleral staphyloma (PS) was divided into 6 types by ultra-wide-angle fundus photography. Logistic regression model was used to analyze the factors related to MTM. Results In 72 eyes, PM, PC and PLH were 72 (100.0%, 72/72), 62 (86.1%, 62/72) and 29 (40.3%, 29/72) eyes, respectively. Among them, there were 10 (13.9%, 10/72) eyes with PM alone, 33 (45.8%, 33/72) eyes with PM and PC, and 29 (40.3%, 29/72) eyes with PM, PC and PLH, respectively. There were 42 eyes with partial PVD (58.3%, 42/72), among which the macular fovea and paravascular adhesion were 22 (52.4%, 22/42) and 24 (57.1%, 24/42) eyes, respectively. PS was present in 50 eyes (69.4%, 50/72), among which 27 (54.0%, 27/50), 21 (42.0%, 21/50), 1 (2.0%, 1/50), and 1 (2.0%, 1/50) eyes were types Ⅰ to Ⅳ, respectively. Multivariate logistic regression analysis showed that AL[odds ratio (OR)=16.139, 95% confidence interval (CI) 4.062-64.120, P＜0.001], PS (OR=4.212, 95%CI 1.234-14.378, P=0.022), paravascular vitreoretinal adhesion (OR=3.478, 95%CI 11.124, P=0.036) were risk factors for PM, PC and PLH. MTM was present in 58 eyes (80.6%, 58/72), among which T1 was the most common type in 19 eyes (26.4%, 19/72). Univariate logistic regression analysis showed that the occurrence of MTM was significantly correlated to PS (OR=4.190, 95%CI 1.240-14.157, P=0.021), coexistence of PM, PC and PLH (OR=11.323, 95%CI 1.389-92.311, P=0.023), and PS were significantly correlated. There was no correlation with PVD (OR=1.889, 95%CI 0.580-6.150, P=0.291) or PS (OR=2.778, 1.786; 95%CI 0.700-11.023; 0.445-7.167; P=0.146, 0.413). There was significant difference in the incidence of severe MTM between PM alone, PM combined with PC and coexistence of PM, PC and PLH (χ²=20.943, P＜0.001). Conclusions PM is the most common and earliest manifestation of PVA in middle-aged and elderly HM patients. AL, PS and paravascular vitreoretinal adhesion are risk factors for PM, PC and PLH. The coexistence of three PVA forms may be a marker of severe MTM.

Citation： Li Xuejing, Cai Zhaoyang, Duan Jialiang, Shang Qingli. Correlation between high myopia paravascular abnormalities and myopic traction maculopathy. Chinese Journal of Ocular Fundus Diseases, 2023, 39(8): 657-663. doi: 10.3760/cma.j.cn511434-20230721-00315 Copy

1.	Shimada N, Ohno-Matsui K, Nishimuta A, et al. Detection of paravascular lamellar holes and other paravascular abnormalities by optical coherence tomography in eyes with high myopia[J]. Ophthalmology, 2008, 115(4): 708-717. DOI: 10.1016/j.ophtha. 2007.04.060.
2.	Ohno-Matsui K, Hayashi K, Tokoro T, et al. Detection of paravascular retinal cysts before using OCT in a highly myopic patient[J]. Graefe's Arch Clin Exp Ophthalmol, 2006, 244(5): 642-644. DOI: 10.1007/s00417-005-0112-6.
3.	Liu HY, Hsieh YT, Yang CM. Paravascular abnormalities in eyes with idiopathic epiretinal membrane[J]. Graefe's Arch Clin Exp Ophthalmol, 2016, 254(9): 1723-1729. DOI: 10.1007/s00417-016-3276-3.
4.	Ruiz-Medrano J, Montero JA, Flores-Moreno I, et al. Myopic maculopathy: current status and proposal for a new classification and grading system (ATN)[J]. Prog Retin Eye Res, 2019, 69: 80-115. DOI: 10.1016/j.preteyeres.2018.10.005.
5.	Kamal-Salah R, Morillo-Sanchez MJ, Rius-Diaz F, et al. Relationship between paravascular abnormalities and foveoschisis in highly myopic patients[J]. Eye (Lond), 2015, 29(2): 280-285. DOI: 10.1038/eye.2014.255.
6.	Li T, Wang X, Zhou Y, et al. Paravascular abnormalities observed by pectral domain optical coherence tomography are risk factors for retinoschisis in eyes with high myopia[J/OL]. Acta Ophthalmol, 2018, 96(4): e515-e523[2017-11-24]. https://pubmed.ncbi.nlm.nih.gov/29171725/. DOI: 10.1111/aos.13628.
7.	Takahashi H, Nakao N, Shinohara K, et al. Posterior vitreous detachment and paravascular retinoschisis in highly myopic young patients detected by ultra-widefield OCT[J/OL]. Sci Rep, 2021, 11(1): 17330[2021-08-30]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405667/. DOI: 10.1038/s41598-021-96783-w.
8.	Takahashi H, Tanaka N, Shinohara K, et al. Importance of paravascular vitreal adhesions for development of myopic macular retinoschisis detected by ultra-widefield OCT[J]. Ophthalmology, 2021, 128(2): 256-265. DOI: 10.1016/j.ophtha.2020.06.063.
9.	趙秀娟, 呂林. 努力加深對近視牽引性黃斑病變的認識, 合理開展手術治療[J]. 中華眼底病雜志, 2020, 36(12): 911-914. DOI: 10.3760/cma.j.cn511434-20201123-00579.Zhao XJ, Lyu L. Enhance the cognition of myopic traction maculopathy to select the surgical approach reasonably[J]. Chin J Ocul Fundus Dis, 2020, 36(12): 911-914. DOI: 10.3760/cma.j.cn511434-20201123-00579.
10.	Shinohara K, Shimada N, Moriyama M, et al. Posterior staphylomas in pathologic myopia imaged by widefield optical coherence tomography[J]. Invest Ophthalmol Vis Sci, 2017, 58(9): 3750-3758. DOI: 10.1167/iovs.17-22319.
11.	Ohno-Matsui K. Proposed classification of posterior staphylomas based on analyses of eye shape by three-dimensional magnetic resonance imaging and wide-field fundus imaging[J]. Ophthalmology, 2014, 121(9): 1798-1809. DOI: 10.1016/j.ophtha.2014.03.035.
12.	Sayanagi K, Ikuno Y, Gomi F, et al. Retinal vascular microfolds in highly myopic eyes[J]. Am J Ophthalmol, 2005, 139(4): 658-663. DOI: 10.1016/j.ajo.2004.11.025.
13.	Tanaka N, Shinohara K, Yokoi T, et al. Posterior staphylomas and scleral curvature in highly myopic children and adolescents investigated by ultra-widefield optical coherence tomography[J/OL]. PLoS One, 2019, 14(6): 0218107[2019-06-10]. https://pubmed.ncbi.nlm.nih.gov/31181108/. DOI: 10.1371/journal.pone.0218107.
14.	Vela JI, Sánchez F, Díaz-Cascajosa J, et al. Incidence and distribution of paravascular lamellar holes and their relationship with macular retinoschisis in highly myopic eyes using spectral-domain OCT[J]. Int Ophthalmol, 2016, 36(2): 247-252. DOI: 10.1007/s10792-015-0110-6.
15.	周麗琴, 夏惠娟, 陳潔. 近視牽引性黃斑病變自然病程進展遠期觀察[J]. 中華眼視光學與視覺科學雜志, 2018, 20(9): 566-571. DOI: 10.3760/cma.j.issn.1674-845X.2018.09.011.Zhou LQ, Xia HJ, Chen J. Long term study of the natural course of myopic traction maculopathy[J]. Chin J Ophthalmol Vis Sci, 2018, 20(9): 566-571. DOI: 10.3760/cma.j.issn.1674-845X.2018.09.011.
16.	Xia HJ, Wang WJ, Chen F, et al. Long-term follow-up of the fellow eye in patients undergoing surgery on one eye for treating myopic traction maculopathy[J/OL]. J Ophthalmol, 2016, 2016: 2989086[2016-07-12]. https://pubmed.ncbi.nlm.nih.gov/27478633/. DOI: 10.1155/2016/2989086.
17.	Parolini B, Palmieri M, Finzi A, et al. The new myopic traction maculopathy staging system[J]. Eur J Ophthalmol, 2021, 31(3): 1299-1312. DOI: 10.1177/1120672120930590.
18.	Lin C, Li SM, Ohno-Matsui K, et al. Five-year incidence and progression of myopic maculopathy in a rural Chinese adult population: the Handan Eye Study[J]. Ophthalmic Physiol Opt, 2018, 38(3): 337-345. DOI: 10.1111/opo.12456.
19.	Tian J, Qi Y, Lin C, et al. The association in myopic tractional maculopathy with myopic atrophy maculopathy[J/OL]. Front Med (Lausanne), 2021, 8: 679192[2021-08-20]. https://pubmed.ncbi.nlm.nih.gov/34490288/. DOI: 10.3389/fmed.2021.679192.
20.	Chen Q, He J, Hu G, et al. Morphological characteristics and risk factors of myopic maculopathy in an older high myopia populationbased on the new classification system (ATN)[J]. Am J Ophthalmol, 2019, 208: 356-366. DOI: 10.1016/j.ajo.2019.07.010.
21.	Ueda E, Yasuda M, Fujiwara K, et al. Five-year incidence of myopic maculopathy in a general Japanese population: the Hisayama study[J]. JAMA Ophthalmol, 2020, 138(8): 887-893. DOI: 10.1001/jamaophthalmol.2020.2211.

1. Shimada N, Ohno-Matsui K, Nishimuta A, et al. Detection of paravascular lamellar holes and other paravascular abnormalities by optical coherence tomography in eyes with high myopia[J]. Ophthalmology, 2008, 115(4): 708-717. DOI: 10.1016/j.ophtha. 2007.04.060.
2. Ohno-Matsui K, Hayashi K, Tokoro T, et al. Detection of paravascular retinal cysts before using OCT in a highly myopic patient[J]. Graefe's Arch Clin Exp Ophthalmol, 2006, 244(5): 642-644. DOI: 10.1007/s00417-005-0112-6.
3. Liu HY, Hsieh YT, Yang CM. Paravascular abnormalities in eyes with idiopathic epiretinal membrane[J]. Graefe's Arch Clin Exp Ophthalmol, 2016, 254(9): 1723-1729. DOI: 10.1007/s00417-016-3276-3.
4. Ruiz-Medrano J, Montero JA, Flores-Moreno I, et al. Myopic maculopathy: current status and proposal for a new classification and grading system (ATN)[J]. Prog Retin Eye Res, 2019, 69: 80-115. DOI: 10.1016/j.preteyeres.2018.10.005.
5. Kamal-Salah R, Morillo-Sanchez MJ, Rius-Diaz F, et al. Relationship between paravascular abnormalities and foveoschisis in highly myopic patients[J]. Eye (Lond), 2015, 29(2): 280-285. DOI: 10.1038/eye.2014.255.
6. Li T, Wang X, Zhou Y, et al. Paravascular abnormalities observed by pectral domain optical coherence tomography are risk factors for retinoschisis in eyes with high myopia[J/OL]. Acta Ophthalmol, 2018, 96(4): e515-e523[2017-11-24]. https://pubmed.ncbi.nlm.nih.gov/29171725/. DOI: 10.1111/aos.13628.
7. Takahashi H, Nakao N, Shinohara K, et al. Posterior vitreous detachment and paravascular retinoschisis in highly myopic young patients detected by ultra-widefield OCT[J/OL]. Sci Rep, 2021, 11(1): 17330[2021-08-30]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405667/. DOI: 10.1038/s41598-021-96783-w.
8. Takahashi H, Tanaka N, Shinohara K, et al. Importance of paravascular vitreal adhesions for development of myopic macular retinoschisis detected by ultra-widefield OCT[J]. Ophthalmology, 2021, 128(2): 256-265. DOI: 10.1016/j.ophtha.2020.06.063.
9. 趙秀娟, 呂林. 努力加深對近視牽引性黃斑病變的認識, 合理開展手術治療[J]. 中華眼底病雜志, 2020, 36(12): 911-914. DOI: 10.3760/cma.j.cn511434-20201123-00579.Zhao XJ, Lyu L. Enhance the cognition of myopic traction maculopathy to select the surgical approach reasonably[J]. Chin J Ocul Fundus Dis, 2020, 36(12): 911-914. DOI: 10.3760/cma.j.cn511434-20201123-00579.
10. Shinohara K, Shimada N, Moriyama M, et al. Posterior staphylomas in pathologic myopia imaged by widefield optical coherence tomography[J]. Invest Ophthalmol Vis Sci, 2017, 58(9): 3750-3758. DOI: 10.1167/iovs.17-22319.
11. Ohno-Matsui K. Proposed classification of posterior staphylomas based on analyses of eye shape by three-dimensional magnetic resonance imaging and wide-field fundus imaging[J]. Ophthalmology, 2014, 121(9): 1798-1809. DOI: 10.1016/j.ophtha.2014.03.035.
12. Sayanagi K, Ikuno Y, Gomi F, et al. Retinal vascular microfolds in highly myopic eyes[J]. Am J Ophthalmol, 2005, 139(4): 658-663. DOI: 10.1016/j.ajo.2004.11.025.
13. Tanaka N, Shinohara K, Yokoi T, et al. Posterior staphylomas and scleral curvature in highly myopic children and adolescents investigated by ultra-widefield optical coherence tomography[J/OL]. PLoS One, 2019, 14(6): 0218107[2019-06-10]. https://pubmed.ncbi.nlm.nih.gov/31181108/. DOI: 10.1371/journal.pone.0218107.
14. Vela JI, Sánchez F, Díaz-Cascajosa J, et al. Incidence and distribution of paravascular lamellar holes and their relationship with macular retinoschisis in highly myopic eyes using spectral-domain OCT[J]. Int Ophthalmol, 2016, 36(2): 247-252. DOI: 10.1007/s10792-015-0110-6.
15. 周麗琴, 夏惠娟, 陳潔. 近視牽引性黃斑病變自然病程進展遠期觀察[J]. 中華眼視光學與視覺科學雜志, 2018, 20(9): 566-571. DOI: 10.3760/cma.j.issn.1674-845X.2018.09.011.Zhou LQ, Xia HJ, Chen J. Long term study of the natural course of myopic traction maculopathy[J]. Chin J Ophthalmol Vis Sci, 2018, 20(9): 566-571. DOI: 10.3760/cma.j.issn.1674-845X.2018.09.011.
16. Xia HJ, Wang WJ, Chen F, et al. Long-term follow-up of the fellow eye in patients undergoing surgery on one eye for treating myopic traction maculopathy[J/OL]. J Ophthalmol, 2016, 2016: 2989086[2016-07-12]. https://pubmed.ncbi.nlm.nih.gov/27478633/. DOI: 10.1155/2016/2989086.
17. Parolini B, Palmieri M, Finzi A, et al. The new myopic traction maculopathy staging system[J]. Eur J Ophthalmol, 2021, 31(3): 1299-1312. DOI: 10.1177/1120672120930590.
18. Lin C, Li SM, Ohno-Matsui K, et al. Five-year incidence and progression of myopic maculopathy in a rural Chinese adult population: the Handan Eye Study[J]. Ophthalmic Physiol Opt, 2018, 38(3): 337-345. DOI: 10.1111/opo.12456.
19. Tian J, Qi Y, Lin C, et al. The association in myopic tractional maculopathy with myopic atrophy maculopathy[J/OL]. Front Med (Lausanne), 2021, 8: 679192[2021-08-20]. https://pubmed.ncbi.nlm.nih.gov/34490288/. DOI: 10.3389/fmed.2021.679192.
20. Chen Q, He J, Hu G, et al. Morphological characteristics and risk factors of myopic maculopathy in an older high myopia populationbased on the new classification system (ATN)[J]. Am J Ophthalmol, 2019, 208: 356-366. DOI: 10.1016/j.ajo.2019.07.010.
21. Ueda E, Yasuda M, Fujiwara K, et al. Five-year incidence of myopic maculopathy in a general Japanese population: the Hisayama study[J]. JAMA Ophthalmol, 2020, 138(8): 887-893. DOI: 10.1001/jamaophthalmol.2020.2211.

Chinese Journal of Ocular Fundus Diseases

Correlation between high myopia paravascular abnormalities and myopic traction maculopathy

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