ObjectiveTo observe the changes of vessel densities (VD) in the macula and optic disc and its correlation with axial length (AL) in pathological myopia (PM). MethodsA retrospective clinical study. A total of 171 eyes from 171 patients admitted to Department of Ophthalmology of Jinshan Hospital of Fudan University from June 2019 to December 2019 were included in this study. Among them, there were 72 males and 99 females; age was 35.0±10.8 years old. The patients were divided into PM group, high myopia (HM) group and non-HM group, 51 cases with 51 eyes, 70 cases with 70 eyes, and 50 cases with 50 eyes, respectively. Optical coherence tomography angiography was used to scan the macular and optic disc areas of all the examined eyes in the range of 6 mm×6 mm. According to the early treatment of diabetic retinopathy study, the 6 mm macular and optic disc scan range was centered on the macular fovea and optic disc, respectively, then divided into two concentric circles with diameters of 1 mm of central area, an annulus between 1-3 mm circles of paracentral area. The paracentral area was divided into superior, inferior, nasal, temporal four quadrants by 2 radiation lines. The VD of superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina, and choriocapillaris layer were calculated in the central, superior, inferior, nasal, and temporal areas, respectively. The VD of PM, HM and non-HM groups were compared. The variance analysis was used to compare the VD among the three groups; Pearson’s correlation was used to assess the correlation between VD and AL. ResultsThe perifoveal VD of the SCP, outer retina and choriocapillaris layers were all lower in the PM than those of HM and non-HM group, and the differences were statistically significant (P＜0.05). The VD of DCP macular central was higher in the PM than in the HM group, and the difference was statistically significant (P=0.020). In the optic disc, the VD were lower in the PM group than in the non-HM group except for the area of DCP superior, inferior, temporal, outer retinal center, and the differences were statistically significant (P＜0.05). The results of correlation analysis showed that the VD in the DCP macular central, ONH superior and the choriocapillaris ONH central were not correlated with AL (P=0.647, 0.688, 0.146), and the other VDs were negatively correlated with AL (P＜0.05). ConclusionCompared with HM and non-HM groups, the majority of VDs in macular and ONH are lower in participants with PM.
Peripapillary intrachoroidal cavitation (PICC) is a common pathological change observed in high myopia. The exact pathogenesis of PICC is still unclear. Expansion and mechanical stretching of the peripapillary sclera, breakage and defect in the retina near the border of the myopic conus and communication between intrachoroidal cavity and the vitreous space may be important segments during the development of PICC. Color fundus photography shows a localized and well-circumscribed peripapillary lesion with yellow-orange colour, often accompanied by fundus changes, such as myopic conus excavation, optic disc tilting and inferotemporal retinal vein bending at the transition from the PICC to the myopic conus. However, the PICC lesion is not easy to be recognized in the fundus photography. Fluorescein angiography shows early hypofluorescence and later progressively staining in the lesion. Indocyanine green angiography shows hypofluorescence throughout the examination. Optical coherence tomography (OCT) is vital in diagnosing PICC. Hyporeflective cavities inside the choroid, sometimes communicating with the vitreous chamber, can be observed in OCT images. OCT angiography indicates lower vessel density or even absence of choriocapillary network inside or around PICC lesions.
ObjectiveTo investigate the changes of choroid thickness in adolescents with different types of non-pathological high myopia (HM). MethodsA retrospective observational study. From January 2021 to April 2022, 179 eyes of 101 adolescents with myopia in Liaocheng Aier Eye Hospital were collected and analyzed. According to the spherical equivalent (SE) and corneal curvature, subjects were divided into mild myopia or emmetical eye group (control group), HM group, occult HM group (OHM group) and super HM group (SHM group). There were 52 eyes in 30 cases, 47 eyes in 26 cases, 42 eyes in 24 cases and 38 eyes in 21 cases, respectively. Medical optometry, intraocular pressure, optical coherence tomography (OCT), axial length (AL) and corneal curvature were measured. The macular foveal choroidal thickness was analyzed by using spectral-domain OCT. The diopter was expressed in SE. The thickness of choroid in the fovea of macular region was measured by enhanced deep imaging with frequency domain OCT. The thickness of choroid was measured in 9 regions within 1 mm, 3 mm from the fovea, including the upper, lower, nasal and temporal regions. Generalized estimating equation was used to compare the data among groups, and the least significant difference t-test was used to compare the data among groups. The correlation between AL, corneal curvature, intraocular pressure and choroidal thickness was analyzed by Pearson correlation. ResultsThe choroidal thickness in the foveal macula and the areas 1 mm and 3 mm away from the fovea were compared among the control group, HM group, OHM group and SHM group, the difference were significant (χ2=76.646, 36.715, 27.660, 35.301, 24.346, 38.093, 36.275, 33.584, 36.050; P＜0.05). Compared with the control group, the choroidal thickness of the fovea and the choroidal thickness in each area within 1 and 3 mm from the fovea in the HM group, the OHM group and the SHM group were significantly thinner than those in the control group, and the difference was statistically significant (P＜0.05). There were statistically significant differences in choroidal thickness in each region between the group and the SHM group, and between the OHM group and the SHM group (P＜0.05). The results of correlation analysis showed that AL was negatively correlated with choroidal thickness in various regions (P＜0.05); SE was positively correlated with choroidal thickness in various regions (P＜0.05); corneal curvature and intraocular pressure had no significant correlation with choroidal thickness in various regions (P＞0.05). ConclusionsThe choroidal thickness of SHM is significantly lower than that of OHM and HM; OHM patients have lower SE. However, the choroidal thickness is significantly thinner. AL and SE are the influencing factors of choroidal thickness.
ObjectiveTo compared the macular blood flow parameters among myopic choroidal neovascularization (mCNV), high myopia (HM) and normal subjects.MethodsRetrospective study. Forty patients (40 eyes) diagnosed as mCNV (mCNV group) in the Eye Hospital of Wenzhou Medical University at Hangzhou from June 2016 to November 2018, age-matched, sex-matched and diopter-matched 40 HM patients (40 eyes, HM group), age-matched and sex-matched 40 healthy persons (40 eyes, normal group) were enrolled in this study. Retina superficial and deep vessel density, the area of foveal avascular zone (FAZ), a-circularity index (AI) and vessel density around the 300 μm width of the FAZ region (FD) on macular 3 mm×3 mm scan on OCTA of 3 groups were compared.ResultsThere were significant differences in the average retina superficial, deep vessel density, the area of FAZ, AI and FD among 3 groups (F=24.82, 9.18, 3.58, 7.68, 14.15; P＜0.05). The average retina superficial and deep vessel density and FD in mCNV group were lower than those in HM group (P＜0.05). The average retina superficial and deep vessel density and FD in HM group were lower than those in control group (P＜0.05). The average area of FAZ in mCNV group was smaller than that in control group (P＜0.05). The average AI in mCNV group was less than that in the other 2 groups (P＜0.05).ConclusionsThe retina superficial, deep vessel density and FD decreased, the area and the form of FAZ remained unchanged in HM subjects comparing with normal subjects. While retina superficial, deep vessel density and FD decreased more, the area of FAZ reduced, the form of FAZ tend to be irregular in mCNV.
ObjectiveThe aim of this study is to observe the clinical characteristics and surgical effects of macular hole retinal detachment in high myopia patients with pars plana vitrectomy (PPV) and secondary internal limiting membrane (ILM) peeling. MethodsThis was a retrospective study. The clinical data of 15 patients (15 eyes)with macular hole retinal detachment and high myopia, who underwent primary PPV and secondary ILM peeling, were analyzed, including disease history, refraction diopter, ocular axis length, posterior scleral staphyloma, BCVA, macular reattachment and macular hole heeling. There were 3 males (3 eyes) and 12 female (12 eyes), the average age was (60.80±5.85)years. All patients were examined by best corrected visual acuity (BCVA), slit lamp microscopy with 90D pre-lens, indirect ophthalmoscopy, A scan and optical coherence tomography (OCT). After the first PPV and silicone oil tamponade, a shallow retinal detachment around the macular hole, especially around the scleral staphyloma was detected by OCT. During the 2nd surgery to remove the silicone oil, ILM peeling and C3F8 tamponade were performed. ResultsThe average refraction diopter was (-12.6±1.86) D, the average ocular axial length (29.82±0.993) mm and the average disease duration was (5.20±1.24) months. All eyes had total retinal detachment of all four quadrants, choroid detachment and macular choroidal atrophy, and type Ⅱ Curtin posterior scleral staphyloma. After the second surgery, all had retina attached by fundus examination. OCT examination indicated that macular hole closure in 7 eye, macular hole attached and retinal attached in 8 eyes. Their BCVA improved after both the first and second surgery (P=0.000), the BCVA after second surgery was better than that after first surgery (P=0.038). ConclusionsThe clinical characteristic of our series of patients were as follows: long history, with choroidal detachment and type Ⅱ Curtin posterior scleral staphyloma. All 15 eyes showed retinal attached after secondary ILM peeling. The secondary ILM peeling and C3F8 tamponade may improve the visual outcome and retinal reattachment rate.
The reattachment rate, macular hole (MH) closure rate, visual acuity improvement and re-detachment 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 re-detachment. 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.
Objective To evaluate the safety and efficacy of brilliant blue G (BBG) assisted internal limiting membrane (ILM) peeling on pathological myopic macular holes with retinal detachment.Methods This is a prospective and noncontrolled study. Twenty-seven high myopia patients （27 eyes） with macular holes and retinal detachment were enrolled. Routine examination was performed, including the best corrected visual acuity （BCVA）, intraocular pressure, slit lamp microscope with +90 D pre-set lens, A- or B-ultrasound,optical coherence tomography (OCT) and visual field. All patients received vitrectomy with BBG-assisted ILM peeling and C3F8 gas tamponade. The 5 followup visits were at the first day, the seventh day, the first month, the third month and the sixth month after surgery. The BCVA, intraocular pressure, visual field, macular hole and retinal reattachment were comparatively analyzed.Results The ILM of all patients were peeled completely by BBG staining. There were no major complications such as corneal edema, anterior chamber reaction, elevated intraocular pressure, visual field defects. At the first month after surgery, macular hole closed and retina reattached in 26 eyes （96.3%）, the macular hole did not close and retina redetached in one eye （25.9%）. At the sixth month after surgery, BCVA of 25 eyes （92.6%） increased, two eyes （7.4%） didnprime;t change, the difference was statistically significant （t＝6.08，Plt;0.05）.Conclusions BBG can fully stain ILM without any side effects. Vitrectomy with BBG-assisted ILM peeling is a safe and effective treatment for pathological myopic macular holes with retinal detachment.
ObjectiveTo objectively quantitative assess the visual quality in patients with myopic foveoschisis (MF) using a double-pass optical quality analysis system (OQASⅡ). MethodsSixty-two subjects participated in this cross-sectional, observational study, who were divided into three groups based on the pathologic conditions including myopic foveoschisis group (MFG), myopic control group (MCG) and normal control group (NCG). Measurements with OQASⅡwere performed for the modulation transfer function cut off frequency (MTF cut-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). ResultsThe mean values for MTF cut-off, SR and OSI of MFG, MCG and 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. ConclusionsThe 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.
ObjectiveTo compare the clinical characteristics and analyze the factors affecting vision prognosis of idiopathic macular hole (IMH) or myopic macular hole (MMH). MethodsA cross-sectional study. From October 2012 to October 2020, 336 patients with 346 eyes of IMH and MMH who were diagnosed in Shanxi Provincial Eye Hospital with continuous follow-up data after surgery were included. There were 346 eyes (336 cases), including IMH with 247 cases (255 eyes) and MMH with 89 cases (91 eyes), which were divided into IMH group and MMH group. Best corrected visual acuity (BCVA) and optical coherence tomography were performed in all eyes. The BCVA examination used the standard logarithmic visual acuity chart, which was converted into logarithmic minimum angle of resolution (logMAR) visual acuity. The age of outset in IMH and MMH was 64.8±6.6 and 59.2±8.1 years, the logMAR BCVA was 1.11±0.50 and 1.80±0.78, respectively. There were significant differences in age (Wald=34.507) and logMAR BCVA (Z=－7.703) between two groups (P＜0.05). All eyes were performed inner limiting membrane (ILM) peeling or partial inverted ILM covering hole operation. After the operation, the vitreous cavity was filled with air, C3F8 and silicone oil, including 73, 102, 83 eyes in IMH group and 9, 10, 72 eyes in MMH group, respectively. Follow-up time after surgery was more than 2 months. The optimal BCVA and macular hole closure of the two groups were observed. If the quantitative data conformed to the normal distribution, the generalized estimating equation was used, otherwise, the Mann-Whitney U test or Kruskal-wallis test was used, the χ2 test was used for the comparison of categorical variables. Generalized estimating equation logistic regression analyzed the influencing factors of optimal BCVA after surgery and visual acuity success. ResultsIn IMH and MMH, the optimal logMAR BCVA were 0.71±0.36, 1.10±0.51 respectively, and 147 (57.6%, 147/255) eyes, 63 (69.2%, 63/91) eyes achieved visual success respectively. There was a significant difference in the optimal logMAR BCVA (Z=－6.803, P＜0.005), but no difference in visual success rate (χ2=3.772) between the two groups. The visual success rate of IMH at the same baseline BCVA level was higher than that of MMH, and the difference was statistically significant (χ2=14.500, P=0.001). Logistic regression analysis showed that the influencing factors predicting poor optimal visual acuity after surgery were: IMH, baseline BCVA [odds ratio (OR)=2.941, 95% confidence interval (CI) 1.341-6.447, P＜0.05], MH diameter (OR=1.003, 95%CI 1.001-1.005, P＜0.05), silicon oil filling (OR=3.481, 95%CI 1.594-7.605, P＜0.05); MMH, baseline BCVA (OR=2.549, 95%CI 1.344-4.834, P＜0.05), C3F8 filling (OR=18.131, 95%CI 1.505-218.365, P＜0.05) and silicon oil filling (OR=7.796, 95%CI 0.997-60.944, P＜0.05). The factors leading to a lower likelihood of achieving visual success: IMH, baseline BCVA (OR=213.329, 95%CI 46.123-986.694, P＜0.05), MH diameter (OR=0.995, 95%CI 0.992-0.997, P＜0.05), silicon oil filling (OR=0.326, 95%CI 0.115-0.926, P＜0.05) and duration (OR=1.036, 95%CI 1.005-1.067, P＜0.05); MMH, baseline BCVA (OR=13.316, 95%CI 2.513-70.565, P＜0.05) and duration (OR=1.022, 95%CI 1.001-1.044, P＜0.05). ConclusionsMMH was earlier than IMH in age of outset. Baseline vision significantly affected vision prognosis in IMH and MMH. Silicone oil should be avoided as much as possible under the premise of hole closure.
ObjectiveTo observe and compare the outcomes of vitrectomy (PPV) combined with complete internal limiting membrane (ILM) peeling and fovea-sparing ILM peeling for the high myopic foveoschisis (MF).MethodsA retrospective case study was performed. From June 2016 to June 2018, 31 eyes of 31 patients with high myopic MF diagnosed in Department of Ophthalmology of Central Theater Command General Hospital were included in the study. There were 9 males and 22 females, who were monocular. The mean age was 57.55±9.45 years. All patients underwent BCVA, diopter, spectral domain OCT and axial length measurement. Snellen visual acuity chart was used for BCVA examination, and which was converted into logMAR visual acuity. According to the surgical method, patients were divided into PPV combined with ILM complete removal group (group A) and PPV combined with retained fovea ILM group (group B), which were 16 patients (16 eyes) and 15 patients (15 eyes ), respectively. The mean logMAR BCVA was 1.03±0.33 in group A and 1.11±0.35 in group B. The mean CFT was 596.51±196.69 μm in group A and 578.33±200.18 μm. There were no statistically significant differences in age (t=0.649, P=0.527), AL (t=－0.639, P=0.533), logMAR BCVA (t=－0.368, P=0.718), CFT (t=0.228, P=0.823) and MF type (P=0.576) between the two groups. The mean follow-up time after operation was 18.65±5.15 months. At 7 d, 1, 3, 6 and 12 months after surgery, and at the last follow-up, the same equipment and methods for relevant examinations. The changes of BCVA, CFT, macular hole and other complications were compared between the two groups. Comparison of BCVA and CFT between the two groups before and after operation was performed by paired t test. The count data were compared by using Fisher exact probability method.ResultsAt the last follow-up, MF was completely restored in 27 eyes (87.1%) of 31 eyes, partially restored in 4 eyes (12.9%). The mean logMAR BCVA of group A and Group B was 0.67±0.24 and 0.64±0.21, respectively. The average CFT was 126.25±36.61 μm and 134.27±25.29 μm, respectively. Compared with pre-operation, BCVA was obviously improved in both groups (t=6.630, 9.260; P=0.000, 0.000), CFT was significantly decreased in both groups (t=10.206, 8.799; P=0.000, 0.000). There were no statistically significant differences in logMAR BCVA and CFT between the two groups (t=0.156, －0.924; P=0.878, 0.371). In group A, full-thickness macular hole occurred in 1 eye (6.3%), while no macular hole occurred in group B. There was no significant difference in macular hole incidence between two groups (χ2=0.969, P=0.516). No intraocular hemorrhage, endophthalmitis and other complications occurred during the follow-up period.ConclusionsPPV combined with ILM peeling or fovea-sparing ILM peeling is effective in the treatment of high myopic MF. Both may contribute to improved MF closure rate and BCVA.