Progression Of Myopic Maculopathy Research Articles

Treatment of macular hole retinal detachment with macular plug in highly myopic eyes: three-year results.

To investigate the long-term surgical outcomes of macular hole retinal detachment (MHRD) following vitrectomy with macular plug in highly myopic eyes. Thirty-five cases of highly myopic eyes with MHRD in 35 patients who underwent an initially successful vitrectomy with macular plug and were followed up for at least 3years were reviewed. The anatomical outcomes were evaluated by fundus examination, fundus photographs and optical coherence tomography (OCT). Myopic features after the surgery were differentiated according to recommendations of the Meta-analysis of Pathologic Myopia (META-PM) Study Group. The best-corrected visual acuities (BCVAs) before and after surgery were analysed as the functional outcome. Main outcome measures time-course changes in BCVA and complications. The mean patient age was 61.0±11.4years. The follow-up was 45.2±8.6months (ranged from 36 to 71months). The mean axial length was 29.3±1.2mm. All eyes demonstrated attached retina, but 2 eyes (5.7%) developed reopened macular holes until the last follow-up. Complications of postoperative rhegmatogenous retinal detachment were detected in 2 eyes (5.7%) within 1year and retina reattached after the secondary vitrectomy. Three cases (8.6%) of prolonged subretinal fluid lasting more than 1year were detected but finally absorbed completely. Comparing 1-3years postoperatively, myopic features showed significant progression of myopic maculopathy category (p=0.035). Functionally, significantly improved BCVA could be maintained postoperatively between 6months and 3years. However, vision of 14 eyes (40.0%) worsened within 1-3years postoperatively, and visual deterioration was associated with progression of myopic maculopathy (p=0.004) and pre-existing disease of glaucoma (p=0.006). A vitrectomy combined with macular plug provided favourable outcomes in the long term, over the ≥3-year follow-up period.

CHARACTERIZATION OF THE CHOROIDAL VASCULATURE IN MYOPIC MACULOPATHY WITH OPTICAL COHERENCE TOMOGRAPHIC ANGIOGRAPHY.

To characterize the choriocapillaris (CC) in highly myopic eyes with myopic maculopathy, using optical coherence tomographic angiography. Prospective, clinic-based study of 42 eyes of 38 patients with high myopia (≤-6 diopters and axial length ≥26.5 mm). Myopic maculopathy was graded from fundus photographs according to the Meta-Analysis for Pathologic Myopia classification. Macular 3 × 3 mm en face optical coherence tomographic angiographic images were obtained with swept-source optical coherence tomographic angiography and graded for CC flow impairment as follows: 1) intact CC, 2) focal (<1 mm), and 3) extensive (>1 mm). Of the 42 eyes, 17 (39.5%) had tessellated fundus, 20 (46.5%) had diffuse, and 6 (14.0%) had patchy atrophy. Choriocapillaris flow impairment was observed in all eyes with diffuse and patchy atrophy. Even in eyes with tessellated fundus only, CC signal voids were seen in 3 eyes (17.6%). With increasingly severe myopic maculopathy, the pattern of CC flow impairment changed from predominantly focal to predominantly extensive. Choriocapillaris flow impairment was observed in many highly myopic eyes, even in those with mild fundus changes, and worsened with increasing severity of myopic maculopathy. Longitudinal studies are needed to assess whether CC flow impairment predicts the risk of myopic maculopathy progression.

Progression of Myopic Maculopathy in Highly Myopic Chinese Eyes.

To evaluate the 2-year changes in myopic maculopathy and its associations in highly myopic eyes. This was a longitudinal, observational cohort study involving 657 Chinese participants with bilateral high myopia (≤ -6.00 diopters spherical power), who were followed for 2 years. The worst eye of each participant was considered for the analysis. Myopic maculopathy was graded based on fundus photographs, using the International Photographic Classification and Grading System for Myopic Maculopathy. The mean baseline age was 21.6 ± 12.2 years (range, 6.8-69.7 years). Myopic maculopathy progressed in 97 (14.8%) of 657 eyes, of which 24 eyes progressed to a higher category of myopic maculopathy, including from no maculopathy to tessellated fundus in 17 eyes, from tessellated fundus to diffuse atrophy in 6 eyes, and from diffuse to patchy atrophy in 1 eye. Among 122 lesion changes identified, the most common changes were enlargement of diffuse atrophy (n = 50, 41.0%), appearance of lacquer cracks (n = 28, 23.0%), enlargement of patchy atrophy (n = 10, 8.2%) and development of additional lacquer cracks (n = 7, 5.8%). In addition, we identified 1 eye with enlargement of a Fuch's spot, and 1 eye with active choroidal neovascularization. In multiple logistic regression analysis, myopic maculopathy progression was associated with older age, longer axial length, greater change in myopic spherical equivalent and more severe myopic maculopathy at baseline. Myopic maculopathy progressed in approximately 15% of highly myopic eyes over a 2-year period. Further studies with longer follow up periods are required to confirm identified risk factors for progression.

Five-year incidence and progression of myopic maculopathy in a rural Chinese adult population: the Handan Eye Study.

To determine the cumulative five-year incidence and progression of myopic maculopathy in a rural Chinese adult population. The Handan Eye Study was a population-based longitudinal study. In 2006, 6830 subjects aged 30+ years participated in this study (baseline). Five years later, 5394 subjects (follow-up rate: 85.3%) took part in the follow-up study. Participants had a detailed eye examination, including visual acuity, standardized refraction and fundus photography according to a similar protocol at both baseline and follow-up. Myopic maculopathy was defined as any of the following signs: diffuse chorioretinal atrophy, patchy chorioretinal atrophy, macular atrophy, lacquer cracks and myopic choroidal neovascularization at the posterior pole. Parapapillary atrophy was assessed separately. Of 5394 participants, 5078 (10021 eyes) had gradable fundus photographs. Over the five years, four participants (five eyes) developed new myopic maculopathy, with an eye-specific incidence of 0.05% (95% CI, 0.02-0.10%). Among the 51 eyes with myopic maculopathy at baseline, the progression occurred in 18 eyes (35.3%), with new signs of patchy chorioretinal atrophy in 11 eyes (21.6%), diffuse chorioretinal atrophy in seven eyes (13.7%), lacquer cracks in three eyes (6.9%), macular atrophy in three eyes (6.9%) and myopic choroidal neovascularization in two eyes (3.9%). By multivariable analysis, female gender (OR, 9.14; p=0.004) and higher educational level (OR, 8.24; p=0.004) were associated with a higher risk of progression of myopic maculopathy, whereas lower myopia at baseline (OR, 0.79; p<0.0001) and hypertension (OR, 0.21; p=0.017) were associated with a reduced risk. The five-year incidence of myopic maculopathy was 0.05% in rural Chinese adults aged 30+years. The progression rate in participants with myopic maculopathy was 35.3%, indicating the importance of regular follow-up for these patients.

Ten-Year Progression of Myopic Maculopathy: The Beijing Eye Study 2001–2011

To investigate the progression pattern of myopic maculopathy and associated factors in a population-based study. Population-based longitudinal study. The Beijing Eye Study including 4439 participants in 2001 was repeated in 2011, with 2695 individuals (66.4%) being re-examined in2011. The study participants underwent detailed ophthalmic and general examinations. Using fundus photographs obtained in 2001 and 2011, we assessed the progression of myopic maculopathy in highly myopic eyes with a refractive error ≥-6 diopters in 2001. Myopic maculopathy was differentiated into tessellated fundus (category 1), diffuse chorioretinal atrophy (category 2), patchy chorioretinal atrophy (category 3), and macular atrophy (category 4), with lacquer cracks and choroidal neovascularization as additional plus signs. Progression pattern of myopic maculopathy. Of 110 highly myopic eyes (70 individuals) at baseline, 39 eyes (35.5%) showed progression observed in 15 of 79 eyes (19%) with tessellated fundus at baseline, in 17 of 24 eyes (71%) with diffuse chorioretinal atrophy, in all 6 eyes with patchy chorioretinal atrophy, and the 1 eye with macular atrophy. Lacquer cracks detected in 2 eyes in 2001 developed into a small patchy atrophy (1 eye) or widened during the follow-up (1 eye). Five eyes demonstrated new lacquer cracks. In binary regression analysis, progression of myopic maculopathy was associated with longer axial length (P < 0.001; odds ratio [OR], 7.13; 95% confidence interval [CI], 2.49-20.4), older age (P= 0.001; OR, 1.25; 95% CI, 1.10-1.42), higher prevalence of staphylomas (P= 0.03; OR, 24.3; 95% CI, 2.89-204), smaller parapapillary γ-zone in 2011 (P= 0.01; OR, 0.61; 95% CI, 0.41-0.91), and female gender (P= 0.04; OR, 9.78; 95% CI, 1.06-90.6). The 10-year progression rate of myopic maculopathy in this elderly Chinese population was 35.5%, increasing from 15 of 79 eyes (19%) in category 1 of myopic maculopathy at baseline to 17 of 24 eyes (71%) in category 2 and 6 of 6 eyes (100%) in category 3. Risk factors for myopic maculopathy progression werelonger axial length, pre-existing staphylomata, smaller parapapillary γ-zone, older age, and female gender.

Progression of Myopic Maculopathy during 18-Year Follow-up

To examine the progression pattern of myopic maculopathy. Retrospective, observational case series. Highly myopic patients who had been followed up for 10 years or more. Using fundus photographs, myopic features were differentiated according to Meta-analysis of Pathologic Myopia (META-PM) Study Group recommendations. Progression pattern of maculopathy. The study included 810 eyes of 432 patients (mean age, 42.3±16.8 years; mean axial length, 28.8±1.9 mm; mean follow-up, 18.7±7.1 years). The progression rate of myopic maculopathy was 47.0 per 1000 eye-years. Within the pathologic myopia (PM) group (n= 521 eyes), progression of myopic maculopathy was associated with female gender (odds ratio [OR], 2.21; P= 0.001), older age (OR, 1.03; P= 0.002), longer axial length (OR, 1.20; P= 0.007), greater axial elongation (OR, 1.45; P= 0.005), and development of parapapillary atrophy (PPA; OR, 3.14; P < 0.001). Diffuse atrophy, found in 217 eyes without choroidal neovascularization (CNV) or lacquer cracks (LCs) at baseline, progressed in 111 (51%) eyes, leading to macular diffuse atrophy (n=64; 64/111 or 58%), patchy atrophy (n= 59; 53%), myopic CNV (n= 18; 16%), LCs (n= 9; 5%), and patchy-related macular atrophy (n= 3; 3%). Patchy atrophy, detected in 63 eyes without CNV or LCs at baseline, showed progression in 60 eyes (95%), leading to enlargement of original patchy atrophy (n= 59; 59/60 or 98%), new patchy atrophy (n= 29; 48%), CNV-related macular atrophy (n= 13; 22%), and patchy-related macular atrophy (n= 5; 8%). Of 66 eyes with LCs, 43 eyes (65%) showed progression with development of new patchy atrophy (n= 38; 38/43 or 88%) and new LCs (n= 7; 16%). Reduction in best-corrected visual acuity (BCVA) was associated mainly (all P < 0.001) with the development of CNV or CNV-related macular atrophy and enlargement of macular atrophy. The most frequent progression patterns were an extension of peripapillary diffuse atrophy to macular diffuse atrophy in diffuse atrophy, enlargement of the original atrophic lesion in patchy atrophy, and development of patchy atrophy in LCs. Main risk factors for progression were older age, longer axial length, and development of PPA.

Progression of Myopic Maculopathy after Treatment of Choroidal Neovascularization

Purpose: To evaluate the long-term progression of myopic maculopathy and functional outcome after treatment of myopic choroidal neovascularization (CNV) with photodynamic therapy (PDT) and/or intravitreal ranibizumab (IVR). Methods: Retrospective study with a cross-sectional evaluation. Eyes were assigned to 4 groups (PDT, IVR, PDT + IVR, dry myopic maculopathy) and evaluated with best-corrected visual acuity, color fundus photography and spectral-domain optical coherence tomography. Chorioretinal atrophy progression was quantified. Results: Fifty-four eyes were included with a mean follow-up of 80.6 ± 28.0 months. The prevalence of diffuse, patchy and macular atrophy increased during the follow-up, in contrast with tessellated fundus, lacquer cracks and active CNV. Progression of macular atrophy was significant in the 3 treatment groups (p < 0.05) and predictive of visual acuity. It depended on age, degree of myopia and presence of staphyloma, but not on the type of treatment. Conclusions: The long-term functional outcome of eyes with myopic CNV is more dependent on the progression of macular atrophy, and not on the type of treatment.

Long-term Pattern of Progression of Myopic Maculopathy: A Natural History Study

To investigate the long-term progression pattern of myopic maculopathy and to determine the visual prognosis of each progression stage.Retrospective, observational case series.The medical records of 806 eyes of 429 consecutive patients with high myopia (refractive error more than -8.00 diopters [D] or axial length > or =26.5 mm) who were followed for 5-32 years were reviewed.Participants had complete ophthalmological examinations including best-corrected visual acuity, axial length measurements, fluorescein angiography, and color fundus photography, at least once a year. The presence and type of posterior staphyloma was determined by binocular stereoscopic ophthalmoscopy. The types of myopic maculopathy included tessellated fundus, lacquer cracks, diffuse chorioretinal atrophy, patchy chorioretinal atrophy, choroidal neovascularization (CNV), and macular atrophy. None of the patients had received any type of treatment for the maculopathy.The longitudinal long-term progression pattern and the visual prognosis of each type of fundus lesion.During the mean follow-up of 12.7 years, 327 of the 806 highly myopic eyes (40.6%) showed a progression of the myopic maculopathy. The most commonly observed patterns were from tessellated fundus to the development of diffuse atrophy and lacquer cracks, an increase in the width and progression to patchy atrophy in eyes with lacquer cracks, an enlargement of the diffuse atrophy, and the development of patchy atrophy in eyes with diffuse atrophy, and an enlargement and fusion of patches of atrophic areas in eyes with patchy atrophy. Eyes with tessellated fundus, lacquer cracks, diffuse atrophy and patchy atrophy at the initial examination progressed to the development of CNV. Eyes with CNV developed macular atrophy. The fusion of patchy atrophy, the development of CNV, and macular atrophy all led to significant visual decreases. A posterior staphyloma was observed more frequently in eyes that showed progression from tessellated fundus, diffuse atrophy, and patchy atrophy than those without a progression.These findings indicate that myopic maculopathy tends to progress in approximately 40% of highly myopic eyes, and the pattern of progression affects the visual prognosis. Preventive therapy targeting posterior staphyloma should be considered to prevent the visual impairment caused by the progression of myopic maculopathy.