High Myopic Eyes Research Articles

Automated Posterior Scleral Topography Assessment for Enhanced Staphyloma Visualization and Quantification With Improved Maculopathy Correlation.

To quantitatively characterize the posterior morphology of high myopia eyes with posterior staphyloma. Surface points of the eyeball were automatically extracted from magnetic resonance imaging scans using deep learning. Subsequently, the topography of posterior staphylomas was constructed to facilitate accurate visualization and quantification of their location and severity. In the three-dimensional Cartesian coordinate system established with surface points, measurements of distances (D) from each point to the hypothetical pre-elongation eye center within the eyeball and local curvatures (C) at each point on the posterior sclera were computed. Using this data, specific parameters were formulated. The concordance of these parameters with traditional staphyloma classification methods and their association with myopic traction maculopathy (MTM) grades based on the ATN classifications were investigated. The study included 102 eyes from 52 participants. The measured parameters, particularly the variance of distance (Dvar) and the maximum value of the curvature and distance product (C · Dmax), demonstrated efficacy in differentiating various types of posterior staphyloma and exhibited strong correlations with the grades of MTM. The automated generation of the posterior scleral topography facilitated visualization and quantification of staphyloma location and severity. Simple geometric parameters can quantify staphyloma shape and correlate well with retinal complications. Future works on expanding these measures to more imaging modalities could improve their clinical use and deepen insights into the link between posterior staphyloma and related retinal diseases. This work has the potential to be translated into clinical practice, allowing for the accurate assessment of staphyloma severity and ultimately improving disease management.

Biomechanical Corneal Effects of LASIK-Xtra Compared to Conventional Femto-LASIK in High Myopic Eyes

Purpose: This study seeks to investigate the in vivo corneal biomechanical response to femtosecond laser-assisted in situ keratomileusis (FS-LASIK) combined with accelerated corneal crosslinking (LASIK-Xtra) compared to conventional FS-LASIK (convLASIK) in highly myopic eyes. Setting: Department of Ophthalmology, Goethe-University, Frankfurt, Germany Design: A prospective, randomized fellow eye-controlled clinical trial Methods: We enrolled patients who received treatment with LASIK-Xtra (30mW/cm2, 90 seconds with continuous UVA) in one eye and convLASIK in the fellow eye. Both eyes were subjected preoperatively and twelve months postoperatively to a Corvis ST examination. The stiffness parameter at first applanation (SP-A1), integrated inverse radius (IIR), deformation amplitude (DA), deformation amplitude 2 mm away from apex and the apical deformation (DARatio2mm) were evaluated. Results: The study included 38 high myopic eyes (-7.34±1.02 diopter) of 19 patients. The results of the corneal biomechanical measurement showed a significant reduction in overall corneal stiffness with a significant decrease in postoperative SP-A1 and increase in IIR, DA, and DARatio2mm (p<.001). In a direct comparison, there was no evidence of an increase in corneal stiffness in the LASIK-Xtra group compared to the convLASIK group twelve months postoperatively. No statistically significant difference was detected in any of the four biomechanical parameters (p>.05). Conclusion: The corneal biomechanical response to convLASIK and LASIK-Xtra did not vary significantly. With a similar corneal thickness-loss, there was no significant difference in the four biomechanical metrics between the convLASIK and LASIK-Xtra groups. Thus, LASIK-Xtra seems not to have a protective corneal stiffening effect compared to convLASIK twelve months postoperatively.

IMPACTS OF POSTERIOR STAPHYLOMA ON PARAPAPILLARY MICROVASCULATURE AND ATROPHY IN HIGH MYOPIC EYES: A MATCHED COHORT STUDY WITH OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

We aimed to evaluate the impacts of the different types of posterior staphyloma (PS) in high myopia on parapapillary microvasculature and parapapillary atrophy (PPA, i.e., γ-zone and δ-zone) with optical coherence tomography angiography. This cross-sectional study included 152 high myopic eyes (152 participants) with γ-zone. After matching, high myopic eyes were stratified into PS (n = 33) and non-PS (n = 33) groups. PS types, parapapillary microvasculature characteristics, the prevalence of non-juxtapapillary microvasculature dropout (NJ-MvD), the longest radial width from the optic disc edge to retinal pigment epithelium atrophy edge (PPA-w), γ-zone, and δ-zone with changes in visual field and best-corrected visual acuity (BCVA) were evaluated and analyzed. According to Curtin's classification, we identified five types of PS included: primary types I, II, III, and compound types VII, and IX. Eyes with type II showed a higher optic disc tilted ratio and larger PPA-w compared to other primary PS. Subjects with type IX were the oldest. Eyes with types VII and IX had wider γ-zone and δ-zone, worse visual field outcomes, poorer BCVA, and a higher incidence of NJ-MvD compared to primary PS. Choroidal and intrascleral vessels were associated with NJ-MvD and were located near or connected to the circle of Zinn-Haller. Eyes with high myopia and PS show wider PPA, affecting the γ-zone and δ-zone, and are at a higher risk of developing NJ-MvD. Specifically, eyes with PS types VII and IX are more susceptible to visual field damage and decreased BCVA. These results highlight the importance of impact of PS on PPM and PPA in high myopia.

Morphologic features of iris in highly myopic eyes based on a novel swept-source optical coherence tomography.

To investigate the morphologic features of iris in the highly myopic (HM) eyes using a novel swept-source optical coherence tomography (SS-OCT). In this retrospective case-control study, 100 eyes of 100 patients scheduled to have cataract surgery were included, categorized into the control (22 mm< AL < 24.5 mm) and HM (AL ≥ 26 mm) groups. Iris volume (IV), area of anterior iris surface (IS), area of posterior IS, and average iris thickness (IT), as well as anterior chamber volume (ACV) and trabecular-iris space at 500 µm (TISA 500) were evaluated using SS-OCT. The associated factors with morphologic features of iris were also investigated. The HM group showed significantly larger IV and area of anterior and posterior IS than the control group (all P < 0.001), while no difference was identified in IT between the groups. Similar trend in IV was seen in the superior and nasal segments, and area of anterior and posterior IS showed similar trends in all segments except the temporal segment. The IV, area of anterior and posterior IS were all positively correlated with AL (all P < 0.001). Multivariate linear regression revealed that a larger IV was associated with greater ACV. Both larger areas of anterior IS and posterior IS were associated with male, longer AL, greater ACV, and smaller TISA 500. The HM eyes showed larger IV and area of IS than the control eyes, indicating a coronal expansion of the iris with AL. Iris morphology correlated with anterior chamber angle configuration.

Clinical efficacy evaluation of the implantation of a diffractive trifocal intraocular lens in high myopia eyes: Two-year follow-up.

To evaluate the long-term subjective and objective visual quality after implantation of a diffractive trifocal intraocular lens (IOL) in high myopic eyes. A total of 53 eyes from 38 patients with high myopia who underwent phacoemulsification and trifocal IOL implantation were investigated. The visual acuity, contrast sensitivity, diopter, defocus curve, and objective visual quality at 1 month, 3 months, 1 year, and 2 years after surgery, as well as the satisfaction questionnaire and VF-14 scale, were statistically analyzed. The average age was 53.14 ± 4.70 years. The average preoperative spherical equivalent was -10.77 ± 3.98 D. Two years after surgery, 94.3% of the patients achieved an uncorrected distance visual acuity of 0.1 (LogMAR), and 84.9% and 94.3% of the patients had SE within ±0.50 D and ±1.0 D, respectively. The defocus curve was smooth and at a high value within the range of 0 D to -2.50 D. In CS or objective visual quality, there was no significant difference at 3 months, 1 year, and 2 years after operation (all P > 0.05). The rate of spectacle independence was 100%. The proportion of patients with moderate or severe glare and halo was 10.5% and 13.2%, respectively. Furthermore, 23.7%, 26.3%, and 18.4% of the patients had difficulties in reading small font, doing delicate tasks, and driving or riding at night, respectively. The diffractive trifocal IOL implantation provided good distance, intermediate, and near uncorrected visual acuity for patients with cataracts and high myopia. It was safe, effective, predictable, and stable. It provided long-term good visual quality after surgery, with high spectacle independence and high patient satisfaction.

SURGICAL OUTCOMES AND INTRAOPERATIVE PARAMETERS OF THREE-DIMENSIONAL VISUALIZATION SYSTEM VERSUS CONVENTIONAL MICROSCOPES FOR MACULAR SURGERY IN HIGHLY MYOPIC EYES: A Prospective Randomized Clinical Trial.

To investigate the surgical outcomes and intraoperative parameters of 3D visualization system for macular diseases in highly myopic eyes. In this single-center, prospective, randomized, comparative interventional study, 40 highly myopic eyes (axial length > 26 mm) were randomly assigned to either a 3D visualization system or a conventional microscope group. Surgical outcomes and intraoperative parameters, including the number of indocyanine green injections, surgical time, and epiretinal membrane/internal limiting membrane peeling time, were compared. The 3D group required significantly fewer indocyanine green injections (1.3 ± 0.5 vs. 2.3 ± 0.7, P < 0.001), had shorter epiretinal membrane/internal limiting membrane peeling times (522.8 ± 258.0 vs. 751.8 ± 320.2 seconds, P < 0.05), and experienced fewer intraoperative retinal hemorrhages (0 vs. 7 cases, P < 0.05) compared with the conventional microscope group. Anatomical and functional outcomes were comparable between the two groups. The 3D system exhibited a lower number of indocyanine green injections, shorter epiretinal membrane/internal limiting membrane peeling times, and a reduced incidence of intraoperative retinal hemorrhages, suggesting the 3D visualization system may offer advantages for macular surgery in highly myopic eyes.

VISION AND METAMORPHOPSIA OUTCOMES OF MACULAR BUCKLING FOR FOVEOSCHISIS-ASSOCIATED MACULAR DETACHMENT IN HIGHLY MYOPIC EYES.

To assess the functional outcomes in visual acuity, metamorphopsia, and vision-related quality of life (VR-QOL) and to evaluate prognostic factors after macular buckling (MB) surgery in eyes with high myopia and foveoschisis (FS)-associated macular detachment (MD). Thirty-nine eyes of 39 patients with FS-associated MD who underwent MB surgery were enrolled. Measured outcomes comprised best-corrected visual acuity (BCVA), metamorphopsia, VR-QOL, axial length (AL), macular reattachment, and resolution of foveoschisis. In addition, factors affecting final BCVA and metamorphopsia were analyzed. At 12 months postoperatively, 36 eyes (92.31%) achieved macular reattachment, 37 eyes (94.87%) achieved complete resolution of foveoschisis, and metamorphopsia diminished in 31 eyes (79.49%). LogMAR BCVAs at baseline and months 1, 3, 6, and 12 postoperatively were 0.62 ± 0.35 (20/83), 0.65 ± 0.3 (20/89), 0.59 ± 0.31 (20/77), 0.54 ± 0.31 (20/69), and 0.46 ± 0.27 (20/57) (P < 0.001), respectively. Metamorphopsia scores by M-CHARTS were 1.36° ± 0.51°, 1.04° ± 0.51°, 0.74° ± 0.47°, 0.59° ± 0.47°, and 0.13° ± 0.29° (P < 0.001). All Visual Function Questionnaire-25 subscales demonstrated significant improvement postoperatively, with the exception of "general health" (P = 0.08) and "driving" (P = 0.111). Preoperative BCVA was an independent risk factor for postoperative BCVA at month 12 (r = 0.638, P < 0.001), and the preoperative M-score was an independent risk factor for postoperative M-score at month 12 (r = 0.187, P = 0.045). MB surgery significantly improved BCVA, metamorphopsia, and VR-QOL in patients with FS-associated MD. Preoperative BCVA and metamorphopsia score were prognostic factors for postoperative BCVA and metamorphopsia score at month 12.

Peripheral Ganglion Cell Complex Thickness and Retinal Microvasculature in Myopia Using Wide-Field Swept-Source OCT.

This study aims to investigate the impact of axial elongation on ganglion cell complex thickness (GCCT) and retinal capillary density (CD) using wide-field swept-source optical coherence tomography angiography. A retrospective cross-sectional analysis was conducted involving 506 eyes. Fovea-centered scans were obtained to assess the subregional GCCT and capillary density across the whole retina, the superficial capillary plexus (SCP), and deep capillary plexus (DCP) among three groups: normal control, high myopia (HM) eyes with axial length < 28mm, and HM eyes with axial length > 28mm. Regional variations (central vs. peripheral, quadrants difference [superior, inferior, nasal, and temporal]) were analyzed. In HM eyes with axial length > 28mm, GCCT and retinal CD exhibit a general decline in most regions (P < 0.05). In HM eyes with axial length < 28mm, significant reductions were observed specifically in peripheral regions, as in the GCCT beyond the 3 × 3mm2 area and CD in the 9-12mm whole retina, 9-12mm superior SCP, and 6-12mm DCP (P < 0.05). Maximum GCCT and retinal CD reduction with axial elongation was observed in subregions beyond 6 × 6 mm2. GCCT beyond the 3 × 3 mm2 area and peripheral retinal CD beyond the 6 × 6 mm2 area were more susceptible to axial elongation and are thereby deserving of particular attention. It is necessary to evaluate different regions during the clinical assessment of the effect of myopia on the fundus and pay close attention to the peripheral retina.

Autostereoscopic 3D viewing can change the dimensions of the crystalline lens in myopes.

Autostereoscopic displays have become increasingly common, but their impact on ocular dimensions remains unknown. We sought to identify changes in the crystalline lens dimensions induced by autostereoscopic three-dimensional (3D) viewing. Forty young adults (age: 22.6 ± 2.0 years, male/female: 15/25) were consecutively enrolled and randomly divided into two groups (3D and two-dimensional [2D] viewing groups) to watch a 30-min movie clip displayed in 3D or 2D mode on a tablet computer. The lens thickness (LT), diameter, curvature, decentration and tilt were measured with anterior segment optical coherence tomography under both non-accommodating (static) and accommodating conditions. In the static condition, the LT decreased by 0.03 ± 0.03 mm (p < 0.001) and the anterior radius of curvature (ARC) increased by 0.49 ± 0.59 mm (p = 0.001) post-3D viewing. In contrast, following 2D viewing, the ARC decreased by 0.23 ± 0.25 mm (p = 0.001). Additionally, the increase in the steep ARC post-3D viewing was greater in high-myopic eyes than low to moderate myopic eyes (p = 0.04). When comparing the accommodative with the static (non-accommodative) condition, for 3D viewing the lens decentration decreased (-0.03 ± 0.05 mm, p = 0.02); while for 2D viewing, the posterior curvature radius (-0.14 ± 0.20 mm, p = 0.006) and diameter (-0.13 ± 0.20 mm, p = 0.01) decreased. Viewing with the autostereoscopic 3D tablet could temporally decrease the thickness and curvature of the lens under non-accommodating conditions. However, its long-term effect requires further exploration.

Lamina Cribrosa Configurations in Highly Myopic and Non-Highly Myopic Eyes: The Beijing Eye Study.

The purpose of this study was to examine characteristics of lamina cribrosa (LC) configuration in highly myopic (HM) eyes. Participants from the Beijing Eye Study 2011, free of optic nerve or retinal diseases, were randomly selected to examine LC depth (LCD) and LC tilt (LCT) using three-dimensional optical coherent tomography images of the optic nerve head (ONH). LCD and LCT were measured as the distance and angle between the LC plane with two reference planes, including the Bruch's membrane opening (BMO) plane and the peripapillary sclera (PPS) plane, respectively. Each parameter was measured in both horizontal and vertical B-scans. The study included 685 individuals (685 eyes) aged 59.6 ± 7.7years, including 72 HM eyes and 613 non-HM eyes. LCD measurements showed no significant differences between HM eyes and non-HM eyes in both horizontal (LCD-BMO = 421.83 ± 107.86µm for HM eyes vs. 447.24 ± 104.94µm for non-HM eyes, P = 0.18; and LCD-PPS = 406.39 ± 127.69µm vs. 394.00 ± 101.64µm, P = 1.00) and vertical directions (LCD-BMO = 435.78 ± 101.29µm vs. 450.97 ± 106.54µm, P = 0.70; and LCD-PPS = 401.62 ± 109.9µm vs. 379.85 ± 110.35µm, P = 0.35). However, the LCT was significantly more negative (tilted) in HM eyes than in non-HM eyes horizontally (LCT-BMO = -4.38 ± 5.94degrees vs. -0.04 ± 5.86degrees, P < 0.001; and LCT-PPS = -3.16 ± 5.23 degrees vs. -0.94 ± 4.71 degrees, P = 0.003), but not vertically (P = 1.00). Although LCD did not differ significantly between HM and non-HM eyes, LCT was more negative in HM eyes, suggesting that the temporal or inferior side of the LC was closer to the reference plane. These findings provide insights into morphological and structural changes in the LC and ONH between HM and non-HM eyes.

Clinical outcomes of a modified ophthalmic viscosurgical device-free implantable collamer lens implantation.

To investigate the efficacy and safety of a modified dual-incision ophthalmic viscosurgical device-free (OVD-free) method for implantable collamer lens (ICL) implantation in high myopic eyes. A total of 68 participants were enrolled in this prospective randomized clinical trial, including 33 in the OVD-free group and 35 in the standard group. Operation time and intraocular pressure (IOP) at 2 hours postoperatively were recorded. Visual acuity, refractive power, IOP, corneal endothelium parameters, and anterior segment parameters were assessed at 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively. Postoperative subjective visual quality at 3 months was recorded through a Quality of Vision (QoV) questionnaire. No significant differences in visual acuity, refractive outcomes, and corneal endothelial parameters were found, while the operation time was significantly shorter in the OVD-free group. Both groups showed a significant increase in IOP at 2 hours after surgery, but the increase in the OVD-free group was significantly smaller than that in the standard group. In addition, the frequency of ring-shaped dysphotopsia in the OVD-free group (15.15%) was significantly lower than that in the standard group (40%), and the severity and annoyance of this symptom were also significantly lower in the OVD-free group. The modified OVD-free ICL implantation is a safe, effective, and predictable method for myopia correction, which could be a better choice for short surgery time, better subjective visual perception, and low occurrence of IOP elevation.

Diagnostic Accuracy of Optic Nerve Head and Macula OCT Parameters for Detecting Glaucoma in Eyes With and Without High Axial Myopia

PurposeTo characterize structural differences and assess the diagnostic accuracy of optic nerve head (ONH) and macula optical coherence tomography (OCT) parameters to detect glaucoma in eyes with and without high axial myopia. DesignCross-sectional study Methods368 glaucoma and 411 healthy eyes with no axial myopia, 393 glaucoma and 271 healthy eyes with mild axial myopia and 124 glaucoma and 85 healthy eyes with high axial myopia were included. Global and sectoral peripapillary retinal nerve fiber layer thickness (pRNFLT), Bruch's membrane opening minimum rim width (BMO-MRW), ganglion cell inner plexiform layer thickness (GCIPLT), and macula RNFLT (mRNFLT) were compared and the diagnostic accuracy for glaucoma detection was evaluated using adjusted area under the receiver operating characteristic curve (AUC). ResultsDiagnostic accuracy for ONH and macula parameters to detect glaucoma was generally high and differed by myopia group. For ONH parameters the diagnostic accuracy was highest for global (AUC=0.95) and inferotemporal (AUC=0.91) pRNFLT for high myopes and global BMO-MRW for non-myopes (AUC=1.0) and mild myopes (AUC=0.97). For macula parameters, the diagnostic accuracy was higher in high myopes with 6 of the 11 GCIPLT global/sectors having adjusted AUCs > 0.90 compared to non-high myopes with no AUCs > 0.90. In all myopia groups, mRNFLT had lower AUCs than GCIPLT. ConclusionsThe diagnostic accuracy for pRNFL and GCIPL was high for high axial myopic eyes and shows promise for glaucoma detection in high myopes. Further analysis is needed to determine whether the high diagnostic accuracy can be confirmed in other populations.

Correlation between axial length and choroidal changes in high myopia

Background Swept-source optical coherence tomography (SS-OCT) can furnish high-resolution structural images of the choroid for chorioretinal atrophy in high myopia. Aim The present study aimed to detect the axial length and choroidal thickness correlation in high myopia using SS-OCT. Using SS-OCT seeks to establish the choroidal thickness and axial length correlation in extreme myopia individuals. Patients and methods A prospective cross-sectional study that was carried out on two groups of patients, group A involved 60 high myopic eyes with myopic refractive error less than or equal to −6.00 diopters (D) and axial length greater than or equal to 26.5 mm which was divided into group A1 which included 30 eyes with axial length less than 29 mm and group A2 that involved 30 eyes with axial length greater than or equal to 29 mm. Group B (control group) included 30 emmetropic eyes with a normal range of axial length (23.5–24.5 mm). Results A high significant axial length was detected in group A2 in contrast to groups A1 and B with P value less than 0.001. The subfoveal choroidal thickness and choroidal thickness in other locations (1 mm superior, 1 mm inferior, 1 mm nasal, and 1 mm temporal to the fovea) were significantly thinner in group A2 than groups A1 and B (P &lt;0.001). A statistically significant inverse correlation (P &lt;0.001) was identified between the choroidal thickness at various locations and the axial length in groups A1 and A2. Conclusion Negative correlation was detected between axial length and both subfoveal choroidal thickness and best corrected visual acuity in patients with high myopia. There was a significant positive correlation between axial length and myopic refractive error.

Anterior Scleral Thickness and Anterior Segment Biometrics Measured with Swept Source Ocular Coherence Tomography in High Myopic Eyes with and without Glaucoma: A Comparative Study.

Background: To assess the anterior scleral thickness (AST), Schlemm's canal diameter (SCD), trabecular meshwork diameter (TMD) and conjunctiva tenon capsule thickness (CTT) in high myopic (HM) subjects and HM subjects with glaucoma (HMG) compared to control eyes. Methods: One hundred and twenty eyes were included, and AST at 0, 1, 2 and 3 mm from the scleral spur, SCD, TMD and CTT were measured. Results: Mean age was 64.2 ± 11.0 years, and the temporal SCD and temporal TMD were significantly longer in the HMG subjects compared to the controls (380.0 ± 62 μm vs. 316.7 ± 72 μm, p = 0.001) and (637.6 ± 113 μm vs. 512.1 ± 97 μm, p = 0.000), respectively. There were no significant differences between the HM and HMG subjects in SCD and TMD (all p > 0.025). Compared to the HM subjects, the temporal AST0 (432.5 ± 79 μm vs. 532.8 ± 99 μm, p = 0.000), temporal AST1 (383.9 ± 64 μm vs. 460.5 ± 80 μm, p = 0.000), temporal AST2 (404.0 ± 68 μm vs. 464.0 ± 88 μm, p = 0.006) and temporal AST3 (403.0 ± 80 μm vs. 458.1 ± 91 μm, p = 0.014) were significantly thinner in the HMG group. No differences were found between the CTT in the three groups (all p > 0.025). Conclusions: Our data indicate a thinner AST in HMG subjects and no differences in SCD and TMD between HM and HMG subjects.

Effectivity and safety of trifocal intraocular lenses and capsular tension rings implantation for cataract patients with axial high myopia.

To assess effectivity and safety of trifocal intraocular lenses (IOLs) and capsular tension rings in treating cataract patients with axial high myopia. A prospective nonrandomized controlled clinical trial was conducted. Totally 98 eyes (74 patients) who underwent femtosecond laser-assisted cataract surgery (FLACS) with trifocal IOLs were enrolled in the study and followed up for 2y after surgery: 46 eyes (33 patients) with capsular tension ring implantation in the long axial lengths (AL) group (26<AL<29 mm) and 52 eyes (41 patients) in the normal AL group (22<AL<24.5 mm). Postoperative outcomes about effectivity and safety, including the subjective and objective visual quality, and postoperative complications were assessed. Uncorrected distance visual acuity at 5 m and uncorrected intermediate visual acuity at 60 and 80 cm in the long AL group were significantly worse than those in the normal AL group at 3mo postoperatively (P<0.05). The differences in reading speed, spectacle independence and potential visual complaints between the two groups were not statistically significant (P>0.05). The dysfunctional lens index and total modulation transfer function (MTF) average height were similar between the two groups. The postoperative internal coma aberrations in the axial high myopia eyes were significantly higher than that in the normal AL group (P<0.05). The total satisfaction score in the long AL group (91.32±2.76) was slightly higher than that in the normal AL group (90.36±3.47), but there was no difference (P=0.136). A statistically negative correlation was found between corrected distance visual acuity (CDVA) and dysfunctional lens index (r=-0.382, P=0.009), and between CDVA and the total MTF average height (r=-0.374, P=0.01). But there was no significant correlation between CDVA and total satisfaction score (r=0.059, P=0.696). Postoperative complications mainly presented as posterior capsular opacity (PCO), retinal detachment and cystoid macular edema. There was no difference in the incidence of fundus disease (6.5% vs 3.8%, P=0.663) or PCO (17.4% vs 7.7%, P=0.217) between the two groups at two years. The utilization of trifocal IOL and capsular tension ring implantation is beneficial for cataract patients with axial high myopia undergoing FLACS. This approach not only ensures excellent subjective feelings and objective visual quality, but also does not increase the incidence of postoperative complications.

Analysis of the therapeutic efficacy of pars plana vitrectomy without intraocular tamponade in the treatment of high myopic eyes with myopic foveoschisis and central foveal detachment

Objective: To investigate the efficacy of pars plana vitrectomy (PPV) without intraocular tamponade in the treatment of high myopic eyes with myopic foveoschisis (MF) accompanied by foveal detachment (FD). Methods: A retrospective case series study was conducted. The medical records of patients diagnosed with unilateral MF accompanied by FD at the Eye & ENT Hospital of Fudan University between May 2018 and December 2021 were collected. All patients underwent 23-gauge PPV with posterior vitreous cortex clearance, and no intraocular tamponade was applied. The cases were divided into groups based on whether the internal limiting membrane was peeled during surgery or retained. Follow-up was conducted for at least 12 months. The main outcome measures included postoperative best-corrected visual acuity (BCVA, converted to logarithm of the minimum angle of resolution), central foveal thickness (CFT), MF resolution, and complications. Statistical analyses were performed using t-tests, chi-square tests, Fisher's exact tests, and univariate and multivariate linear regression. Results: A total of 40 patients (40 eyes) with MF and FD were included in the study, with 30.0% being male and 70.0% female. The mean age was (56.9±11.7) years, and the axial length of the eyes was (29.1±1.9) mm. At 12 months postoperatively, BCVA improved from baseline 1.15±0.58 to 0.73±0.39 (t=6.11, P<0.001), and CFT decreased from baseline (610.1±207.2) μm to (155.9±104.1) μm (t=13.47, P<0.001). Complete resolution of MF with foveal reattachment was observed in 80.0% of eyes, with a median time of 6 (5, 8) months. There was no significant difference in BCVA and CFT between the internal limiting membrane peeled group and retained group [0.68±0.39 vs. 0.79±0.40, t=0.85, P=0.403; (148.3±63.8)vs.(164.3±137.2)um,t=0.48, P=0.634]. One eye experienced macular hole and another eye developed retinal detachment postoperatively. Correlation analysis showed a positive correlation between BCVA at 12 months postoperatively and baseline BCVA (β=0.433, P<0.001). Conclusions: Pars plana vitrectomy without intraocular tamponade is effective in treating MF accompanied by FD. The choice between internal limiting membrane peeling and retention does not significantly affect visual prognosis.

Relationship between automated choroidal thickness measurements and retinal sensitivity using microperimetry in patients with myopia and different stages of myopic maculopathy

PurposeTo assess the relationship between macular choroidal thickness (CT) measurements and retinal sensitivity (RS) in eyes with myopia and different stages of myopic maculopathy.MethodsA masked, cross-sectional, and consecutive study involving patients with emmetropia/myopia (control group) and high myopia (HM) eyes. Automated choroidal thickness (CT) and manual outer retinal layer (ORL) thickness were acquired using swept-source optical coherence tomography, while retinal sensitivity (RS) assessed by microperimetry (MP3) in all regions of the macular Early Treatment Diabetic Retinopathy Study (ETDRS) grid. Comparisons were made between groups, and correlations were performed among these measurements, demographic and ocular parameters and myopic maculopathy classification.ResultsA total of 37 (74 eyes) patients were included in the study. The mean age was 39 ± 13 years, and 28 patients (76%) were female. HM eyes exhibited inferior best-corrected visual acuity and a more advanced myopic maculopathy classification compared to the control group. The mean macular CT were 255 and 179 μm in the control and HM eyes (P < 0.001), respectively. In the HM eyes, superior ETDRS region presented the greatest values. Mean RS in control and HM groups was 28 and 24 dB (P = 0.001), respectively. Inner temporal followed by superior, were the regions of higher RS. Mean ORL thickness was 83 and 79 μm (P < 0.001), in the control and HM groups, respectively. The inner temporal ETDRS region presented the thickest measure. CT correlated significantly with RS (r = 0.41, P < 0.001) and ORL thickness, (r = 0.58, P < 0.001), which also correlated with RS (r = 0.40, P < 0.001). Spherical equivalent, axial length and myopic maculopathy stage were the parameters that most correlated with CT, RS and ORL thickness. For every 100 μm increase in thickening of CT there was an average increase of 3.4 μm in ORL thickness and 2.7 dB in RS. Myopic maculopathy classification demonstrated influence only with CT.ConclusionMyopia degree is related to ORL and choroidal thinning and deterioration of retinal sensitivity in some ETDRS regions of the macula. Choroidal thinning is associated to with a decline of retinal sensitivity, thinning of ORL, and worsening of myopic maculopathy classification, so new treatments are necessary to prevent myopia progression.

Variations in choroidal thickness between emmetropic and myopic eyes after caffeine intake.

To investigate the variations in choroidal thinning between emmetropic and myopic subjects after caffeine intake. Forty-five healthy participants (age mean ± standard deviation [SD]: 20.75 ± 1.6 years) recruited in a prospective cross-sectional study. They were divided into three groups, based on refractive error status, emmetropes (spherical equivalent [SE] -0.25 to +0.25D), myopes (SE ≥-0.50D to ˂-6.00D), and high myopes (SE ≥-6.00D). The participants underwent choroidal thickness [ChT] measurements using optical coherence tomography [OCT] (Topcon 3D OCT-1 Maestro System) at baseline, 20, 40, and 60 minutes after consuming 200 mg of caffeine. The measurements of ChT were taken from five different areas horizontally. Compared to baseline measurement, the ChT significantly decreased after 200 mg caffeine intake in all conditions ( P < 0.001). There was a statistically significant difference in ChT at baseline between the refractive groups ( χ2 (2)=6.548, P = 0.038) as the high myope group showed lesser horizontal ChT within Nasal at (1 mm) area compared to the myope group ( P = 0.032), however, no other significant differences in mean scores of horizontal ChT at baseline were found. The thinning in ChT in the high myope group was lesser compared to both emmetrope and myope groups; however, it was not statistically significant ( P > 0.05). The results of this study suggest that the reduction in ChT due to caffeine consumption is not significantly affected by the refractive status of the eye. Thus, it is safe to hypothesize that the vascular part of the choroid behaves identically to vasoconstrictive in both emmetropic and myopic eyes. The choroidal thinning found in myopic and high myopic eyes and/or the reduced choroidal vascularity index were not apparent in this study. Therefore, further longitudinal studies recruiting greater numbers of participants, including myopes and high myopes, and measuring both vascular and stromal layers to investigate such variations are warranted.

LONGITUDINAL CHANGES OF POSTERIOR VORTEX VEINS IN HIGHLY MYOPIC EYES DETERMINED BY RETROSPECTIVE ANALYSES OF INDOCYANINE GREEN ANGIOGRAMS.

To assess the longitudinal changes of the posterior vortex veins (VVs) in highly myopic (HM) eyes. The medical records of 1,730 consecutive HM eyes that had undergone indocyanine green angiography were studied. Eyes that had posterior VVs and had undergone at least two indocyanine green angiography examinations with a minimum interval of 3 years were selected from this group. Ninety-one eyes of 78 patients met the inclusion criteria. A total of 124 posterior VVs were identified. Over an average interval of 7.8 ± 5.0 years, 41 (33.1%) of the 124 posterior VVs had marked changes consisting mainly of an attenuation of vessels in 36 posterior VVs (87.8%) and alterations in the drainage course in 16 posterior VVs (39.0%). Fifteen posterior VVs had both types of changes. Most of the attenuations of the vessels occurred for smaller branches, but a complete loss of the entire trunk was seen in three eyes. Additionally, four eyes had posterior VV changes in association with changes of peripheral VVs. Posterior VV in highly myopic eyes can undergo changes with increasing time. The associated factors included the development and progression of myopic maculopathy lesions. In some cases, the blood drainage shifted from posterior VV to peripheral VV by forming anastomotic channels.

Ultra-Wide-Field Optical Coherence Tomography and Gaussian Curvature to Assess Macular and Paravascular Retinoschisis in High Myopia

To evaluate the severity and related factors of macular retinoschisis (MRS) and paravascular retinoschisis (PVRS) in high myopia (HM) using ultra-wide-field optical coherence tomography (UWF-OCT) and a novel Gaussian curvature (K). A cross-sectional study. Patients diagnosed with HM in Peking Union Medical College Hospital were recruited between January 2022 and November 2022. The presence and severity of retinoschisis, along with the three highest K values, were assessed using UWF-OCT and en face images. Logistic regressions were employed to identify factors associated with MRS, PVRS, and the severity of retinoschisis in the 24 × 20 mm scan region. A total of 108 HM eyes from 55 patients were recruited. The highest Gaussian curvature (K1) was predominantly found in the vascular arcade (43, 40%). Multivariable logistic regression found that age and PVRS were significant risk factors for MRS occurrence (P < .05), while MRS and higher K1 were significantly associated with the presence of PVRS in HM patients (P < .05). The axial length (AL) and spherical equivalent were associated with the severity of MRS, while AL and K1 values were associated with the severity of retinoschisis in the 24 × 20 mm scan region (P < .05). An association existed between large Gaussian curvature and the presence of MRS and PVRS, as well as the severity of retinoschisis in a wide field of view. UWF-OCT, which enables visualization of the central and peripheral retinal areas, holds promise as an imaging technique for the early detection of extrafoveal retinoschisis.