Objective To study the global and histological changes of myopia and explore its pathogenic mechanism. Methods Chicks were reared with monocular suture of eyelid. When myopia had been confirmed by optometry, eyeballs were removed and subjected subsequently to measurement and light and electron microscopies. Results Three dimensions in the eyeballs of suture group were all enlarged markedly and the mean diopter was -15.00D. Under the light microscope, rod outer segment elongated and connected With PREC in suture group. With micrometer measure, cartilaginous sclera thickened and retina became thinner. Under electron microscope, rod outer segment elongated and membrane disc was intact. In the cytoplasm of RPEC, the phagosomes containing fractions of the membrane disc of outer segment were remarkably decreased. Conclusion Early form deprivation may affect the drop of membrane disc and cause eyeball enlargement; thus, myopia forms. (Chin J Ocul Fundus Dis,1999,15:20-23)
ObjectiveTo observe the efficacy of different administration of conbercept on choroidal neovasculature (CNV) in patients with pathological myopia (PM).MethodsA retrospective case-control study. From June 2012 to June 2017, 57 patients (61 eyes) with PM-CNV diagnosed in the Ophthalmology Department of General Hospital of Central Theater Command were included in this study. All patients underwent BCVA, intraocular pressure, refractive index, slit lamp microscope, FFA, OCT examination and axial length (AL) measurement. An international standard vision chart was used in the BCVA test, which was converted to logMAR vision. According to the initial treatment plan, the patients were divided into 1+PRN treatment group (group A) and 3+PRN treatment group (group B), with 27 patients (31 eyes) and 30 patients (30 eyes), respectively. There was no significantly statistical difference in baseline data between the two groups (P＞0.05). The eyes was injected with 10 mg/ml of conbercept 0.05 ml (including conbercept 0.5 mg). After completion of initial treatment, on-demand treatment was performed according to repeated treatment standards. The average follow-up time was 30.8 months. The time point for curative effect determination was 24 months after treatment. The frequency and recurrence rate of vitreous cavity injections in the two groups of patients and the changes of BCVA, central macular thickness (CMT), diopter and AL were compared and observed. Continuous variables were compared between groups by independent sample t test. Categorical variables were compared by χ2 test. logMAR BCVA and injection frequency were compared by Wilcoxon rank test. Comparison of CMT before and after treatment was performed by paired t test.ResultsAfter 24 months, the number of intravitreal injections in group A and group B were 3.94±1.88 and 4.83±1.72, respectively, with statistically significant difference (Z=－2.182, P=0.029). After completion of initial treatment, the number of retreatments in group A and group B were 2.94±1.88 and 1.83±1.72, respectively, with significantly statistical different (Z=－2.330, P=0.020). The CNV recurrence rates were 38.71% and 13.33%, respectively, with statistically significant difference (χ2=5.074, P=0.024). Compared with prior treatment, the average BCVA at 1, 3, 6, 12, and 24 months after treatment significantly increased in group A and B (Group A: Z=5.634, 5.367, 5.532, 6.344, 6.135l; P＜0.05. Group B: Z=5.809, 5.090, 5.341, 5.939, 8.103; P＜0.05). At 1, 3, 6, and 12 months after treatment, there was no statistically significant difference in the average BCVA of the two groups (Z=－0.966, －0.932, －0.523, －1.759; P=0.334, 0.351, 0.601,0.079); the difference was statistically significant at 24 months (Z=－2.525, P=0.012). Compared with CMT before treatment, the difference in the average CMT reduction of the eyes in groups A and B was statistically significant at 1, 3, 6, 12, and 24 months (Group A: t=4.691, 2.624, 2.121, 1.921, 2.237; P＜0.05. Group B: t=4.947, 4.554, 5.290, 5.567, 5.314; P＜0.05); the average CMT comparison between the two groups was not statistically significant (P=0.457, 0.871, 0.505, 0.333, 0.798). During the follow-up period, there were no ocular complications and systemic adverse reactions.ConclusionsDifferent administration methods for the treatment of PM-CNV by intravitreal injection of conbercept are safe and effective, which can effectively improve BCVA and reduce CMT. Total injection of 3+PRN is more than 1+PRN. However, the injections of retreatment and CNV recurrence rate is lower, and the final follow-up vision is better.
For choroidal neovascularization (CNV) secondary to pathological myopia, intravitreal injection of anti-VEGF has been widely used in clinic and achieved good outcome. However, due to the differences in the demographic characteristics, stages of disease progression and treatment procedure of CNV, the prognosis of the disease is variable. Complete ellipsoid band, smaller baseline choroidal neovascularization and better baseline vision are important predictors of good outcome of anti-vascular endothelial growth factor treatment. Chorioretinal atrophy or complications related to pathologic myopia indicate a poor prognosis. The influence of age, race, previous photodynamic therapy and early treatment on the prognosis of treatment need to be further studied.
With the surged prevalence of myopia, the pathogenic mechanism underlying myopia has attracted attention. At present, it is generally believed in the flied that the reduced blood perfusion in the choroid is crucial for myopigenesis. Then, in the process of myopigenesis, how are the blurred visual signals transmitted to the choroidal blood vessels through the retina and retinal pigment epithelium, leading to the reduced choroidal blood perfusion. The cellular and molecular mechanisms underpinning this process remain elusive. In recent years, the theory of scleral hypoxia has attracted much attention. Popular signaling molecules in current research include dopamine, epidermal growth factor, retinoic acid, cholinergic molecules and adenosine, etc. These factors are likely to participate in signal transduction in retina and RPE, thus causing changes in choroidal blood flow and affecting the occurrence and development of myopia. Therefore, these signaling factors and their downstream pathways may provide new ideas for the prevention and control of myopia targets.
The fundus lesions caused by high myopia (HM) often lead to irreversible visual impairment or even blindness. However, the pathogenesis of HM and its fundus lesions is still unclear, the intraocular fluid detection technology of micro samples has brought new prospects for the early diagnosis, monitoring and intervention of the fundus lesions. The molecules associated with HM are various and functionally diverse, intermolecular interactions are staggered and the specific mechanism is complex. With the development of intraocular fluid detection technology, while gradually revealing the role of each molecule in the pathogenesis of HM, it is expected to successfully assist clinical work in the future, providing outpost markers for the progress of myopia and targets for early intervention, or providing a new therapy choice for HM fundus lesions at the molecular level targeting pathogenesis, which is expected to provide more accurate and effective treatment for HM patients in the future.
ObjectiveTo investigate the effect of “noncycloplegic retinoscopy for screening myopia + subsequent wearing orthokeratology lens” process for primary and secondary school students based on physical examination center.MethodsA total of 172 primary and secondary school students undergoing vision examination in the Health Management Department (i.e. physical examination center) of the Second Affiliated Hospital of Xi’an Jiaotong University between January 2017 and December 2018 were selected as the research objects. After examination by noncycloplegic retinoscopy in the health management department, they were examined by mydriatic retinoscopy in the ophthalmology department, and then the consistency of the results of the two methods was analyzed. Then 93 students with myopia diagnosed by both methods were randomly divided into control group (n=46) and trial group (n=47), wearing frame glasses and orthokeratology lenses respectively. The diopter, eye axial length, corneal curvature and vitreous cavity depth before wearing glasses, as well as the increment of the above indicators at 3, 6 and 12 months after wearing glasses/lenses were compared between the two groups, and the incidence of complications of the two groups were compared.ResultsCompared with mydriatic retinoscopy, the positive predictive value of noncycloplegic retinoscopy was 88.6%, the sensitivity was 96.9% and the specificity was 84.2%, and the consistency kappa coefficient was 0.821 (P<0.001). Before wearing glasses/lenses, there was no significant difference in diopter, eye axial length, corneal curvature or vitreous cavity depth of both eyes between the two groups (P>0.05); at 3, 6 and 12 months after wearing glasses/lenses, the diopter increment and eye axial increment of both eyes of the trial group were less than those of the control group [left eye diopter increment: (0.48±0.07) vs. (0.73±0.08) D, (0.69±0.13) vs. (1.04±0.11) D, (0.88±0.11) vs. (1.13±0.11) D; left eye axial increment: (0.18±0.05) vs. (0.26±0.04)mm, (0.22±0.04) vs. (0.36±0.04) mm, (0.27±0.05) vs. (0.40±0.05) mm; right eye diopter increment: (0.46±0.10) vs. (0.73±0.09) D, (0.71±0.12) vs. (1.04±0.10) D, (0.90±0.10) vs. (1.17±0.11) D; right eye axial increment: (0.17±0.04) vs. (0.24±0.04) mm, (0.23±0.04) vs. (0.37±0.04) mm, (0.26±0.05) vs. (0.42±0.05) mm] (P<0.05). At 3, 6 and 12 months after wearing glasses/lenses, the changing trends of corneal curvature and vitreous cavity depth in both eyes of the trial group were different from those of the control group (PInteraction<0.05), and the corneal curvature of both eyes at each time point was lower than that before wearing lenses and that of the control group (P<0.05), while the vitreous cavity depth of both eyes was not statistically different from that before wearing lenses (P>0.05) but lower than that of the control group (P<0.05). There was no statistical difference in the incidence of common complications between the two groups (P>0.05).ConclusionIn the physical examination center, the accuracy of noncycloplegic retinoscopy for general survey of myopia in primary and secondary school students is high, and then after the diagnosis by mydriatic retinoscopy in the special department, the use of orthokeratology lens can effectively control the progress of myopia, so the process of “noncycloplegic retinoscopy for screening myopia in physical examination center + subsequent wearing orthokeratology lens in specialty” is feasible.
Pathological myopia is one of the most challenging clinical diseases in the field of ophthalmology. The accurate definition, standard classification, disease evolution mechanism and disease prevention and treatment strategies are still under investigation. The development and application of artificial intelligence provides a powerful tool for the analysis of pathological myopia related data. More and more accurate data information is obtained in the clinical work and clinical research of pathological myopia through the standardized collection and acquisition of the fundus image data, the automatic segmentation and quantitative analysis of the fundus physiological structure, the automatic detection and analysis of the pathological myopia classic lesions and the clinical diagnosis and treatment decision aid, which helps ophthalmologists to understand the pathogenesis and evolution of pathological myopia.
High myopia is a disease with a high incidence rate and an increasing trend, which could lead to irreversible visual impairment worldwide. Myopia traction maculopathy (MTM), belonging to one of the pathological changes of high myopia, could cause vision damage and even blindness in patients. Recently, a new classification of MTM based on optical coherence tomography can effectively evaluate the condition of patients and is helpful for the diagnosis and treatment of MTM. Moreover, the improvement of internal limiting membrane peeling method and the innovation of macular buckle material provide new ideas for the treatment of MTM based on traditional surgery. New treatment such as vitreal traction release laser surgery, enzymatic vitreolysis and posterior scleral crosslinking have gained increasing attention. By combining these new treatments with artificial intelligence, 3D printing technology and advanced vitrectomy equipment, it is hoped that a safer and more effective treatment for MTM will be found in the future.
ObjectiveTo observe the correlation between posterior myopic retinoschisis(MRS) and posterior scleral staphyma (PS) in pathological myopia (PM), and to preliminarily explore the influencing factors of MRS.MethodsA retrospective case series study. From November 2016 to November 2019, 38 patients with PM with MRS diagnosed in Henan Eye Hospital & Henan Eye Institute from were included in the study. There were 10 males and 28 females; 13 patients were binocular and 25 patients were monocular. The average age was (49±13) years old. BCVA, retinoscopy optometry, frequency domain OCT, three-dimensional magnetic resonance imaging (3D-MRI) examination and axial length (AL) measurement were performed. According to the frequency domain OCT inspection results, MRS was divided into inner splitting, outer splitting and mixed splitting; based on the 3D-MRI scan results, PS was divided into broad macula, narrow macula,discoid, nasal, subdisc and other types. The correlation between MRS and PS was tested by χ2 test or Fisher exact test.ResultsAmong 60 eyes, 58 eyes (96.77%) of MRS combined with PS. Among them, the wide macula, narrow macula, discoid, nasal, subdisc, and other types were 30 (51.72%), 19 (32.75%), 1 (1.72%), 2 (3.48%), 2 (3.48%) and 4 (6.85%) eyes; inner split, outer split, and mixed split were 10 (17.24%), 24 (41.38%), 24 (41.38%) eyes. Of the 19 eyes with narrow macular PS, MRS involved the fovea in 16 eyes; of the 39 eyes with PS of other forms, MRS involved the fovea in 22 eyes. There was a statistically significant difference between the narrow macular type and other types involving foveal eyes (P=0.044). The correlation between MRS involving the fovea and narrow macular PS was moderate (Cramer's V=0.275). The ages of patients with inner split, outer split, and mixed split were 44±12, 56±10, and 44±13 years, respectively. Patients with inner splitting were younger than those with outer splitting, and those with outer splitting were older than those with inner splitting and mixed splitting. The differences were statistically significant (P=0.010, 0.010, 0.060).ConclusionPM with MRS mostly occur in PS-affected eyes, and mainly macular PS (wide macula, narrow macula).
Objective To observe the long-term efficacy and safety of macular buckling (MB) in the treatment of high myopia traction maculopathy. MethodsA retrospective clinical study. From January 2014 to December 2017, 57 eyes of 57 patients with high myopia traction maculopathy who underwent MB treatment at Zhongshan Ophthalmic Center of Sun Yat-sen University were included in the study. Among them, there were 15 males with 15 eyes, average age was 51.80±10.72 years; there were 42 females with 42 eyes, average age was 59.14±11.51 years. There were 21 eyes of 21 cases with highly myopic macular hole with macular detachment (MHMD), and 36 eyes in 36 cases with highly myopic foveoschisis with macular detachment (FSMD), and they were grouped accordingly. All patients underwent best corrected visual acuity (BCVA), optical coherence tomography (OCT), and axial length (AL) measurements. The standard logarithmic visual acuity chart was used for BCVA examination, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. All patients underwent MB, either on its own or combined with vitrectomy. Patients with significant vitreous macular traction on OCT were treated with combined surgery. One, 3, 6 months and 1, 2, 3, and 4 years after the operation, the same equipment and methods before the operation were used to conduct related examinations, and the long-term efficacy and safety of the two groups of eyes were observed. ResultsBefore surgery, the logMAR BCVA of eyes in MHMD group and FSMD group were 1.35±0.47 and 1.17±0.59, respectively; 4 years after surgery, they were 1.02±0.49 and 0.73±0.55, respectively. The BCVA improved significantly at postoperative 4 years than preoperative in both groups (P=0.039, 0.001). In the eyes with MHMD, the BCVA was found to be significant improved 3 years after surgery (P=0.042). Whereas, in the eyes with FSMD, the BCVA was found to be significantly improved 3 months after surgery (P=0.013). Macular reattachment was achieved in 100% of cases, while macular hole closure rate was achieved in 66.7% in the MHMD group. In the FSMD group, either macular reattachment rate or the foveoschisis resolution rate was 97.2%. After surgery, choroidal neovascularization was observed in 2 eyes, and 3 eyes with intraretinal cyst. ConclusionMB may represent a safe and effective surgical option for the treatment of high myopia maculopathy.