Chorioretinal Atrophy Research Articles

Intraocular complement activation is related to retinal vascular and neuronal degeneration in myopic retinopathy.

To investigate the relationship between the intraocular levels of complement proteins and myopia-related retinal neuronal and vascular degeneration. Aqueous humour from 147 myopic patients, including 60 low-myopia and 87 high-myopia were collected during Implantable Collamer Lens implantation surgery. All participants received comprehensive ophthalmic examinations, including logMAR best corrected visual acuity, axial length measurement, fundus photography and ocular B-scan ultrasonography. The myopic eyes were further classified into simple myopia (SM, n = 78), myopic posterior staphyloma (PS, n = 39) and PS with myopic chorioretinal atrophy (PS + CA, n = 30). Retinal thickness and vascular density in the macula (6 mm × 6 mm) and optic nerve head (4.5 mm × 4.5 mm) were measured using Optical Coherence Tomography (OCT) and OCT angiography (OCTA). The levels of complement proteins including C1q, C3, C3b/iC3b, C4, CFB, CFH, C2, C4b, C5, C5a, CFD, MBL and CFI in the aqueous humour were measured using the Luminex Multiplexing system. The real-time RT-PCR was conducted to examine the expression of complement genes (C1q, C2, C3, C4, CFI and CFD) in the guinea pig model of long-term form deprivation-induced myopic retinal degeneration. OCTA showed that retinal neuronal thickness and vascular density in superficial and deep layers of the macular zone as well as vascular density in the optic nerve head were progressively decreased from SM to PS and PS + CA (p < 0.05). The aqueous humour levels of C1q, C3, C3b/iC3b, C4, CFB, CFH, C2, C4b, C5 and CFI were significantly higher in high-myopic eyes compared to those in low-myopic eyes. Further subgroup analysis revealed the highest levels of complement components/fragments in the PS + CA group. The intraocular levels of complement factors particularly C3b/iC3b and C4 were negatively correlated with macular zone deep layer retinal thickness and vascular density and optic nerve head vascular density. The expression of C2, C3 and C4 genes was significantly higher in guinea pig eyes with myopic retinal degeneration compared to control eyes. The intraocular classical pathway and alternative pathway of the complement system are partially activated in pathological myopia. Their activation is related to the degeneration of retinal neurons and the vasculature in the macula and the vasculature in the optic nerve head.

Ten-year visual outcome and change in chorioretinal atrophy after intravitreal ranibizumab for macular neovascularization in pathologic myopia.

To investigate the 10-year visual outcome and chorioretinal atrophy after a single intravitreal ranibizumab injection (IVR) followed by a pro re nata (PRN) regimen for myopic macular neovascularization (mMNV) in pathologic myopia, and to identify the factors associated with 10-year best-corrected visual acuity (BCVA). This retrospective observational study evaluated 26 consecutive treatment-naïve eyes (26 patients) with mMNV in pathologic myopia who underwent a single IVR followed by a PRN regimen of IVR and/or intravitreal aflibercept injection and observed over 10 years. We assessed changes in BCVA and morphological parameters, including the META-PM Study category as a chorioretinal atrophy index. The logarithm of the minimum angle of resolution BCVA changed from 0.36 (Snellen, 20/45) ± 0.39 to 0.39 (20/49) ± 0.36 over 10 years of observation. Compared to baseline, 1-year BCVA improved (P = 0.002), whereas 2-10-year BCVA was not significantly different. Total injection frequency was 3.8 ± 2.6. In none of the eyes, 10-year BCVA was 20/200 or less. Ten-year BCVA correlated with baseline BCVA (P = 0.01, r = 0.47). The META-PM Study category progressed in 60% of eyes. There were no drug-induced complications. BCVA in eyes with mMNV in pathologic myopia was maintained for 10 years after a single IVR followed by a PRN regimen without drug-induced complications. The META-PM Study category progressed in 60% of eyes, especially those with older baseline age. Early diagnosis and treatment of mMNV are essential to maintain good long-term BCVA.

Microvasculature and microstructure alteration in dry-type high myopia.

To investigate the alterations in the retinal vasculature and microstructure in dry-type high myopia. One hundred and eighty-nine dry-type high myopia eyes were classified into three groups. Group 1 consisted of 86 eyes with no myopic retinal degenerative lesion (C0). Group 2 consisted of 71 eyes with tessellated fundus (C1). Group 3 consisted of 32 eyes with diffuse chorioretinal atrophy (C2). Retinal vascular density and retinal thickness were measured with optical coherence tomography angiography. The scanning area was a 3 × 3 mm2 ring with the fovea of the macular. All data were analyzed with the SPSS 23.0 by one-way ANOVA test among comparison groups. Pearson's correlation analysis was used to determine the relations among measurements. Univariate linear regression showed a correlation between the vascular densities and retinal thicknesses. The microvessel density significantly decreased and significant thinning of the superior and temporal macular thickness in the C2 group. The vascular densities of macular decreased significantly with the increase of axial length (AL) and refractive diopter in the C2 group. The retinal thicknesses of the macular fovea increased significantly with the increase of vascular densities in the C0 group and C1 group. The impairment of retinal microstructure is more likely related to reduced oxygen and nutrients due to microvessel density decreases.

Association Between Choroidal Thickness and Myopic Maculopathy in a Japanese Population: The Hisayama Study

To examine the association between choroidal thickness and myopic maculopathy in a general Japanese population. Population-based cross-sectional study. A total of 2841 residents of a Japanese community aged ≥ 40 years, who consented to participate and had available data of choroidal thickness and fundus photographs, were enrolled in this study. The choroidal thickness was measured by swept-source OCT. Participants were divided into quartiles of choroidal thickness. Myopic maculopathy was defined according to the classification system of the Meta-analysis of Pathologic Myopia Study Group. Main outcome measures were odds ratios (ORs) of choroidal thickness for prevalent myopic maculopathy. The ORs and 95% confidence intervals (CIs) were estimated using a logistic regression model. Prevalent myopic maculopathy. Eighty-one participants had myopic maculopathy (45 diffuse chorioretinal atrophy, 31 patchy chorioretinal atrophy, and 5 macular atrophy). Individuals in the lowest quartile of choroidal thickness had a significantly greater OR for the presence of myopic maculopathy than those in the highest quartile of choroidal thickness (OR: 4.78 [95% CI: 1.78-16.72]) after adjusting for confounders, including axial length. The sensitivity analysis among the 1176 myopic individuals with axial length of ≥ 24.0 mm also showed that thinner choroidal thickness was significantly associated with prevalent myopic maculopathy. The present study demonstrated the significant inverse association between choroidal thickness and the likelihood of myopic maculopathy, suggesting that the measurement of choroidal thickness in addition to axial length would be useful for assessing the risk of myopic maculopathy and elucidating its pathogenesis. Proprietary or commercial disclosure may be found after the references.

Correlation of Visual Acuity and Outer Retinal Thickness in Myopic Atrophic Maculopathy: A Retrospective Review.

Myopic atrophic maculopathy is prevalent among patients with pathologic myopia and frequently leads to relentless vision loss. Several grading systems were established to facilitate the understanding of myopic atrophic maculopathy. However, the anatomical details in different stages of myopic maculopathy are so far not clearly elucidated. This study aims to investigate the visual acuity and retinal sublayer features in highly myopic eyes with varying severities of myopic atrophic maculopathy (MAM). The clinical records of 111 consecutive patients (158 eyes) with high myopia (refractive error ≤ -6.0 D and axial length ≥ 26.0mm) were reviewed. Fundus photography, optical coherence tomography (OCT), and best-corrected visual acuity (BCVA) were measured. MAM was graded according to the META-analysis for Pathologic Myopia (META-PM) classification system. Myopic choroidal neovascularization (mCNV) and dome-shaped macula (DSM) were also investigated. Among the 158 eyes, 18 (11%), 21(13%), 24 (15%), 25 (16%), 23 (15%), and 24 (15%) had tessellated fundus, diffuse chorioretinal atrophy, diffuse chorioretinal atrophy with DSM, patchy atrophy, patchy atrophy with DSM, and MAM with mCNV, respectively. A total of 23 (15%) eyes had macular atrophy without mCNV. Progressive thinning in the Henle's fiber and outer nuclear layers, myoid and ellipsoid zone (MEZ), outer segment (OS), and interdigitation zone and retinal pigmented epithelium based on the severity of MAM (p-value < 0.001) was found. MEZ and OS were most significantly reduced in thickness (p-value < 0.001). The presence of mCNV demonstrated significant outer retinal layer thinning compared with that of the tessellated fundus (p-value = 0.031). Patchy atrophy with DSM showed statistically poorer BCVA compared with that without (p-value = 0.008). Visual acuity and outer retinal sublayer characteristics were correlated with the severity of MAM. Outer retinal sublayer analysis by spectrum-domain OCT shed some light on the mechanisms of MAM progression.

Risk of adverse pregnancy and infant outcomes associated with prenatal Zika virus infection: a post-epidemic cohort in Central-West Brazil

This study aimed to estimate the risks of adverse infant outcomes in the first year of life related to prenatal Zika virus (ZIKV) exposure. A prospective cohort of pregnant women with rash was recruited in Central-West Brazil in a post-epidemic period (January 2017 to April 2019). We evaluated participants’ medical histories and performed ZIKV diagnostic testing using molecular (reverse transcription polymerase chain reaction [RT-PCR]) and serologic (immunoglobulin [Ig]M and plaque reduction neutralization tests [PRNT90]) assays. The ZIKV-positive group included both RT-PCR-confirmed cases as well as IgM and/or PRNT90-positive probable cases. Children were evaluated at birth and in the first 12 months of life. Transfontanellar ultrasound, central nervous system computed tomography, eye fundoscopy and retinography were performed. We estimated the absolute risk and 95% confidence interval (95% CI) of adverse infant outcomes among confirmed prenatally ZIKV-exposed children. Among 81 pregnant women with rash, 43 (53.1%) were ZIKV infected. The absolute risk of microcephaly among offspring of ZIKV-infected pregnant women was 7.0% (95% CI: 1.5–19.1), including the two cases of microcephaly detected prenatally and one detected postnatally. In total, 54.5% (95% CI: 39.8–68.7) of children in the ZIKV-exposed group had at least one ophthalmic abnormality, with the most frequent abnormalities being focal pigmentary mottling and chorioretinal atrophy or scarring. Our findings reinforce the importance of long-term monitoring of prenatally ZIKV-exposed children born apparently asymptomatic for Congenital Zika Syndrome.

NOTCH2NLC GGC repeat expansion causes retinal pathology with intranuclear inclusions throughout the retina and causes visual impairment

The retinal pathology of genetically confirmed neuronal intranuclear inclusion disease (NIID) is yet unknown. We report the ocular findings in four NIID patients with NOTCH2NLC GGC repeat expansion to investigate the pathology of retinopathy. All four NIID patients were diagnosed by skin biopsy and NOTCH2NLC GGC repeat analysis. Ocular findings in patients with NIID were studied using fundus photographs, optical coherence tomographic images (OCT), and full-field electroretinograms (ERGs). The histopathology of the retina was studied on autopsy samples from two cases with immunohistochemistry. All patients had an expansion of the GGC repeat (87–134 repeats) in the NOTCH2NLC. Two patients were legally blind and had been diagnosed with retinitis pigmentosa prior to the diagnosis of NIID and assessed with whole exome sequencing to rule out comorbidity with other retinal diseases. Fundus photographs around the posterior pole showed chorioretinal atrophy in the peripapillary regions. OCT showed thinning of the retina. ERGs showed various abnormalities in cases. The histopathology of autopsy samples showed diffusely scattered intranuclear inclusions throughout the retina from the retinal pigment epithelium to the ganglion cell layer, and optic nerve glial cells. And severe gliosis was observed in retina and optic nerve. The NOTCH2NLC GGC repeat expansion causes numerous intranuclear inclusions in the retina and optic nerve cells and gliosis. Visual dysfunction could be the first sign of NIID. We should consider NIID as one of the causes of retinal dystrophy and investigate the GGC repeat expansion in NOTCH2NLC.

Comment on the Article: Subretinal Bleb of Voretigene Neparvovec.

To the Editor: We studied with great interest the article Subretinal Bleb of Voretigene Neparvovec by João Pedro Marques et al.1 Demonstrating new ways of sub-retinal bleb formation in the process of voretigene neparvovec application provides important upgrades of the surgical technique.1 However, we would like to address some potential bias of the surgical protocol that may confound the final outcomes and propose an alternate approach based on our own experience. We hypothesize that performing only one bleb in the process of subretinal voretigene application, following a saline prebleb, could lead to perifoveal chorioretinal atrophy. Utilizing saline in the process of pre-bleb formation, dilutes the concentration of the vector and possibly lowers the risk of toxicity2 but calls the efficacy in question on the other hand. The concept of creating only a single bleb and accordingly, instilling the total volume of the drug subretinally, carries a higher risk of foveal rupture due to uncontrolled and excessive retinal stretching. Furthermore, completely detached fovea could be mis-located during the ensuing process of subretinal voretigene neparvovec resorption. Thus, to deliver the total amount of the prescribed volume, it seems rational to distribute it to more than a single bleb. Performing more than one bleb lowers the volume of voretigene neparvovec within a single bleb, and additionally, prevents the detachment of the fovea. Finalization with a fluid-air exchange in the vitreous cavity provides both tamponade and allows a gentler and more favorable subretinal spreading of the drug into the subfoveal space compared to dynamically robust separation of the retinal neuroepithelium by subretinal instillation of the total drug volume in a single shot either manually or by subretinal injector with viscous fluid injection. Leon Marković, MD*† Damir Bosnar, MD, PhD*†‡ Mirjana Bjeloš, MD, PhD*†‡

Prevalence and associated health and lifestyle factors of myopic maculopathy in northern China: the Kailuan eye study

BackgroundTo evaluate the prevalence and associated health and lifestyle factors of myopic maculopathy (MM) in a northern Chinese industrial city.MethodsThe cross-sectional Kailuan Eye Study included subjects who participated in the longitudinal Kailuan Study in 2016. Ophthalmologic and general examinations were performed on all the participants. MM was graded based on fundus photographs using the International Photographic Classification and Grading System. The prevalence of MM was evaluated. Univariate and multiple logistic regression were adopted to evaluated risk factors of MM.ResultsThe study included 8330 participants with gradable fundus photographs for MM and ocular biometry data. The prevalence of MM was 1.11% (93/8330; 95% confidence interval [CI] 0.89–1.33%). Diffuse chorioretinal atrophy, patchy chorioretinal atrophy, macular atrophy, and plus lesions were observed in 72 (0.9%), 15 (0.2%), 6 (0.007%), and 32 eyes (0.4%), respectively. MM was more common in eyes with longer axial length (OR 4.517; 95%CI 3.273 to 6.235) and in participants with hypertension (OR 3.460; 95%CI 1.152 to 10.391), and older age (OR 1.084; 95%CI 1.036 to 1.134).ConclusionsThe MM was present in 1.11% of the northern Chinese individuals 21 years or older and the associate factors include longer axial length, older age, and hypertension.

Automated detection of myopic maculopathy using five-category models based on vision outlooker for visual recognition.

To propose a five-category model for the automatic detection of myopic macular lesions to help grassroots medical institutions conduct preliminary screening of myopic macular lesions from limited number of color fundus images. First, 1,750 fundus images of non-myopic retinal lesions and four categories of pathological myopic maculopathy were collected, graded, and labeled. Subsequently, three five-classification models based on Vision Outlooker for Visual Recognition (VOLO), EfficientNetV2, and ResNet50 for detecting myopic maculopathy were trained with data-augmented images, and the diagnostic results of the different trained models were compared and analyzed. The main evaluation metrics were sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), area under the curve (AUC), kappa and accuracy, and receiver operating characteristic curve (ROC). The diagnostic accuracy of the VOLO-D2 model was 96.60% with a kappa value of 95.60%. All indicators used for the diagnosis of myopia-free macular degeneration were 100%. The sensitivity, NPV, specificity, and PPV for diagnosis of leopard fundus were 96.43, 98.33, 100, and 100%, respectively. The sensitivity, specificity, PPV, and NPV for the diagnosis of diffuse chorioretinal atrophy were 96.88, 98.59, 93.94, and 99.29%, respectively. The sensitivity, specificity, PPV, and NPV for the diagnosis of patchy chorioretinal atrophy were 92.31, 99.26, 97.30, and 97.81%, respectively. The sensitivity, specificity, PPV, and NPV for the diagnosis of macular atrophy were 100, 98.10, 84.21, and 100%, respectively. The VOLO-D2 model accurately identified myopia-free macular lesions and four pathological myopia-related macular lesions with high sensitivity and specificity. It can be used in screening pathological myopic macular lesions and can help ophthalmologists and primary medical institution providers complete the initial screening diagnosis of patients.

Preliminary assessment of Onchocerca-induced visual impairment using clinical fundus camera in Gashaka local government area of Taraba state, north eastern Nigeria

IntroductionOnchocerciasis is the world's second leading cause of infectious blindness and remains a major problem in parts of Africa. In light of the efforts targeted towards improving ongoing elimination program, this study assessed onchocerca-induced visual impairments in Gashaka local government areas (LGA) in Taraba State, north-eastern Nigeria. MethodsIn 2019, we recruited 158 consenting visually impaired persons across three communities in Garbabi ward of Gashaka LGA. To avoid confusion with co-endemic trachoma, the integrity of the tarsal conjunctiva, eyelashes were assessed using direct light. The anterior segment of the eye was also examined using a torchlight with oblique illumination. However, the posterior segment of the eye was assessed using a fundus camera. Two photographic images for the left and right eye of each participant were captured using the clinical fundus camera. The photographic eye images that were too dark were discarded, and only clear images were analyzed by two ophthalmologists. An ocular manifestation report was recorded for each participant following consensus between the ophthalmologists. ResultsOf the 316 photographic eye images, almost half 146 (46.2%) from 73 participants were just too destroyed for light to penetrate and was not included in the analysis. Only 170 from 85 participants were clear and examinable. A total of 33 (39%) participants had chorioretinitis suggestive of onchocerciasis, including 22(25.9%) with chorio-retinal atrophy, 7(8.2%) and 4(4.7%) had chorioretinal atrophy in combination with early cataract and signs of trachoma respectively. In addition, 3(3.5%) of the participant had eye images which showed lens opacities, 1(1.2%) showed signs of keratoconus and 1(1.2%) showed a scared and pigmented cornea, possibly due to onchocerciasis. Furthermore, 28 (32.9%) had some ill-defined changes and 19 (22.4%) showed poorly defined chorio-retinal atrophy. ConclusionIn a bid to sustain MDA gains towards elimination of onchocerciasis, this work highlights the need for continuous assessment of onchocerciasis induced visual impairment, strengthening of ivermectin delivery and optimizing compliance and patient care among affected populations. These would require resource acquisition and local capacity building. Our preliminary findings call for further operational research on ocular morbidity as well as future stakeholders' consultations in this important and understudied area.

Diagnostic and Management Strategies of Bietti Crystalline Dystrophy: Current Perspectives.

Bietti crystalline dystrophy (BCD) is a rare, genetically determined chorioretinal dystrophy presenting with intraretinal crystalline deposits and varying degrees of progressive chorioretinal atrophy commencing at the posterior pole. In some cases, there can be concomitant corneal crystals noted first in the superior or inferior limbus. CYP4V2 gene, a member of the cytochrome P450 family is responsible for the disease and more than 100 mutations have been defined thus far. However, a genotype-phenotype correlation has not been established yet. Visual impairment commonly occurs between the second and third decades of life. By the fifth or sixth decade of life, vision loss can become so severe that the patient may potentially become legally blind. Multitudes of multimodal imaging modalities can be utilized to demonstrate the clinical features, course, and complications of the disease. This present review aims to reiterate the clinical features of BCD, update the clinical perspectives with the help of multimodal imaging techniques, and overview its genetic background with future therapeutic approaches.

Full-field Scotopic Threshold Improvement after Voretigene Neparvovec-rzyl Treatment Correlates with Chorioretinal Atrophy

To analyze demographic and ophthalmic data in patients with and without chorioretinal atrophy after voretigene neparvovec-rzyl (VN) to identify possible causes for this phenomenon. Retrospective cohort study with longitudinal follow-up. A total of 71 eyes of 38 patients aged 2 to 44 years with RPE65-mediated retinal dystrophy treated with VN across 2 large gene therapy centers in the United States and Germany. Patients treated with VN who developed atrophy were compared with those who did not. Gender, age, surgical center, spherical equivalent refraction, best-corrected visual acuity (BCVA), baseline full-field scotopic threshold testing (FST), and posttreatment change in FST. A total of 20 eyes of 12 patients developed atrophy after treatment with VN (28% of all eyes). There was no significant difference in gender, age, surgical center, or spherical equivalent refraction between the atrophy group and the no atrophy group. However, patients between school age and young adulthood were predominantly affected, whereas the youngest and the oldest patients did not develop atrophy. Baseline BCVA was better in patients who developed atrophy than those who did not (P= 0.006). The postoperative improvement in FST at 1 month was significantly higher in the atrophy group than in the no atrophy group (P= 0.0005), and this difference remained statistically significant at 1 year (P= 0.0001). There was no correlation to baseline FST, to inflammation, or to which eye was treated first. The degree of FST improvement after VN appears to be strongly correlated with the development of VN-related chorioretinal atrophy. This finding raises the possibility that atrophy may develop as a toxic or metabolic sequela of vector-mediated RPE65 expression. In light of the expanding number of retinal gene therapy clinical trials, this complication warrants further study because it may not be limited to VN. Proprietary or commercial disclosure may be found after the references.

RPGRIP1 variant associated with pigmented paravenous chorioretinal atrophy.

To report a case of Pigmented Paravenous Chorioretinal Atrophy (PPCRA) associated with a novel RPGRIP1 dominant variant. Case report. The patient underwent multimodal retinal imaging, including spectral-domain optical coherence tomography (OCT), OCT Angiography (OCTA), blue-light autofluorescence (BAF), and ultra-widefield pseudocolor retinography and autofluorescence. Genetic testing was performed using next-generation sequencing. A 67-year-old male presented with a clinical suspicion of retinitis pigmentosa. His best-corrected visual acuity was 20/32 in the right eye and 20/200 in the left eye. On fundus examination, paravenous pigment clumping and chorioretinal atrophy were seen bilaterally, matching confluent hypoautofluorescent areas departing from the optic disc. This clinical presentation suggested a case of PPCRA. Genetic testing found a heterozygous deletion of nucleotide 631 (c.631del) in the RPGRIP1 gene, a frameshift variant that generates a premature stop codon (p.Ser211Valfs*64) and therefore results in a truncated or absent protein product. The variant was regarded as likely pathogenic (class IV). In this report, we describe a case of PPCRA in association with a novel, likely pathogenic c.631del, p.Ser211Valfs*64 variant in RPGRIP1, a gene that has been associated with Leber congenital amaurosis and cone-rod dystrophy. Our case expands the spectrum of genes associated with PPCRA and prompts further studies to ascertain the molecular etiopathogenesis of this disease.

Pseudocoloboma-like maculopathy with biallelic RDH12 missense mutations

BackgroundHereditary maculopathy is a group of clinically and genetically heterogeneous disorders. With distinctive clinical features, subtypes of macular atrophy may correlate with their genetic defects.MethodsSeven patients from six families with...

Myopic macular diseases: A review.

Recent evidence has demonstrated that the global public health burden of myopia is rising rapidly. Highly myopic eyes are associated with increased frequency of eye disorders that can lead to irreversible visual impairment. With recent technological advancement in ophthalmic imaging modalities, various macular complications associated with pathologic myopia are being elucidated. The development and progression of myopic chorioretinal atrophy, myopic macular neovascularization, myopic traction maculopathy and dome-shaped macula are vision-threatening myopic macular diseases. In order to overcome the challenges in managing patients with pathologic myopia, it is important to have a complete understanding in the natural course of these myopic macular diseases. Standardising the classification criteria of pathologic myopia is essential for enhancing clinical surveillance. Personalised pharmaceutical therapy and surgical interventions will help to optimise the treatment outcomes in patients suffering from these myopic macular diseases.

Pigmented paravenous chorioretinal atrophy: A fortuitous finding in a patient with fronto-ethmoidal mucocoele

Pigmented paravenous chorioretinal atrophy: A fortuitous finding in a patient with fronto-ethmoidal mucocoele

Macular Neovascularization in a Patient with Pigmented Paravenous Chorioretinal Atrophy

Macular Neovascularization in a Patient with Pigmented Paravenous Chorioretinal Atrophy

Заболевания глазного яблока, ассоциированные с патологической близорукостью

Summary. Myopia is a condition characterized by a refractive error due to the lengthening of the anterior-posterior lengthof the eyeball; among all types of refractive errors, myopia is the most common. To date, the number of patients with myopia tends to increase, which is primarily due to the lifestyle of modern people. The increase in the number of patients with myopia is also due to hereditary factors. Pathologic myopia, manifested by a combination of an increase in the anteriorposterior axis of the eye and characteristic changes in the fundus, is a threat of loss of central vision, and is also associated with the risk of other diseases of eye structures. Pathologic myopia can be a predictor of diseases such as primary open-angle glaucoma, rhegmatogenous retinal detachment, myopic choroidal neovascularization, chorioretinal atrophy. Pathologic myopia is also characterized by the development of dystrophic changes in the periphery of the retina, thinning of the sclera, choroid, changes in the optic nerve head, formation of staphylomas, etc. Currently, the problems of myopia progression, an increase in the number of patients with pathologic myopia are the most relevant, and to prevent it, all available methods for the timely diagnosis of myopia and control of its progression should be applied. Key words: myopia; retina; macula; glaucoma.

High local control and low ocular toxicity using ultra-low-dose "boom-boom" radiotherapy for indolent orbital lymphoma.

The first line definitive treatment for early-stage indolent B-cell lymphoma is radiation therapy (RT). Due to the sensitivity of orbital structures to radiation, ultra-low-dose RT (4 Gy in 2 fractions, "boom-boom") has and been utilized as an attractive option for orbital lymphoma. In this retrospective study, we evaluated the outcome and toxicity of "boom-boom" RT for indolent orbital lymphoma with an emphasis on ophthalmologic toxicity. This is a retrospective case series with 17 patients with orbital lymphoma who received boom-boom RT at a single tertiary referral center between January 2017 and June 2022. Medical records, imaging and radiation treatment plans were reviewed. Endpoints included response rate, progression, and ocular toxicity per oncologist and ophthalmology reports. A total of 17 patients (12 female and 5 male) with 19 indolent orbital lymphomas were included. Median follow-up was 39 months. Complete, partial, and stable response was achieved in 65%, 24%, and 12% of patients, respectively. Only 1 patient developed local recurrent 47 month after radiation treatment, and was successfully salvaged with standard dose radiation (24 Gy). Five-year distant progression rate is 18%. Oncologist-reported Common Terminology Criteria for Adverse Events (CTCAE) toxicity rates were 6% grade 1 and 0% grade 2+. Ophthalmologist reported 33.3% new post-RT toxicities including dry eye, cataract, and chorioretinal atrophy. There is no significant vision acuity change after RT. "Boom-Boom" RT (4 Gy in 2 fractions) provides excellent control for indolent orbital lymphoma. While minimal toxicity was documented by radiation oncologists, higher rates were noted by ophthalmologists, highlighting the radiosensitivity of orbital structures and potentially underreported ocular toxicity in "boom-boom" and standard regimens. Further prospective randomized studies are needed to better define the outcome and toxicity of ultra-low-dose (4 Gy) RT for ocular lymphoma.