Pathological myopic macular retinoschisis can be classified into 4 types based on optical coherence tomography (OCT) images: outer layer retinoschisis, outer + middle layer retinoschisis, outer + inner layer retinoschisis and multilayer retinoschisis. Currently vitrectomy is the major option to treat this condition as it can remove the posterior vitreous cortex completely and peel the internal limiting membrane (ILM) around the posterior vessels arch. Vitrectomy benefits the visual function significantly for outer layer retinoschisis with foveal detachment, but has no or very little effects on multilayer retinoschisis. The appropriate starting site for removal of posterior cortex and ILM should be the site without inner layer retinoschisis. The knowledge and understanding of the OCT classification of pathological myopic macular retinoschisis is important for us to chose correct operation methods and determine the prognosis after treatment.
Objective To evaluate the therapeutic effects of vitrectomy with internal limiting membrane (ILM) peeling on retinal detachment in eyes with high myopia. Methods The clinical data of 25 high myopia patients (25 eyes) with retinal detachment and macular hole were retrospectively analyzed. The patients were divided into two groups according to the treatment:13 patients in group A had undergone conventional vitrectomy;12 patients in group B had undergone vitrectomy and ILM peeling.All patients had been tamponaded by inert gas and kept in a facedown position for 7-15 days after the operation. The followup period was 6-18 months (average 10 months).LogMAR visual acuity, ocular fundus, B-scan ultrasonography and optical coherence tomography had been followed up.Results Retinal reattachment was found in 7 eyes (53.8%) in group A and 11 eyes in group B (91.7%), the difference was significant(chi;2=4.427, P=0.046).The macular hole closed in 6 eyes (46.2%) in group A, and 11 eyes (91.7%) in group B; the difference was significant between those two groups (chi;2=5.940，P=0.020). The postoperative visual acuity increased significantly in both groups(Z=-2.045,2.481;P=0.041,0.012), the difference of vision improvement was not significant between those two groups (MannWhitnay U＝51.5，P=0.16). Conclusions By completely releasing the macular traction and increasing retinal flexibility, vitrectomy with ILM peeling can significantly increase the rate of retinal reattachment and closure of macular hole in eyes with high myopia.
Objective To observe the ef?cacy of pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of myopic macular retinoschisis (MF). Methods This is a retrospective case study. A total of 35 MF patients (36 eyes) were enrolled in this study. There were 5 males (5 eyes) and 30 females (31 eyes), with an average age of (60.13±10.00) years. All patients were examined for best corrected visual acuity (BCVA), diopter, optical coherence tomography (OCT) and axial length. The patients were divided into a MF group (group A, 10 eyes), MF with foveal detachment group (group B, 12 eyes) and MF with lamellar macular hole group (group C, 14 eyes) according to the OCT characteristics. There was no difference of age, gender, spherical equivalent refraction and axial length among 3 groups (F=0.020, 0.624, 0.009, 0.195; P＞0.05). There were significant differences of the minimum resolution angle logarithm (logMAR) BCVA and central fovea thickness (CFT) (F=11.100, 41.790; P＜0.05). All patients underwent pars plana vitrectomy with ILM peeling and gas tamponade. The follow-up was more than one year. The BCVA and macular structure at the final follow-up were analyzed. The efficacy between 3 forms of MF was compared. Results At the final follow-up, the BCVA was 0.40±0.44 and CFT was (213.35±97.58) μm, which were significantly improved compared with preoperative measurements (t=5.984, 5.113; P＜0.001). MF was resolved in 33 eyes. In group A, B and C, the logMAR BCVA were 0.13±0.10, 0.73±0.33 and 0.38±0.52, respectively; CFT was (222.40±57.16), (212.50±150.45), (206.67±55.97) μm, respectively; MF was resolved in 10, 11 and 12 eyes, respectively; complete ellipsoid was observe in 8, 2 and 12 eyes. The logMAR BCVA (F=6.750, P=0.003) and the rate of complete ellipsoid (χ2=18.590, P＜0.001) in group B was lower than group A and C, the differences were significant. There was no difference of CFT (F=0.068, P=0.935) and the rate of MF resolving (χ2=1.558, P=0.459) among the three groups. One eye (1/14) in group C suffered from full layer macular hole. Conclusion Pars plana vitrectomy with ILM peeling and gas tamponade is effective in the treatment of myopic macular retinoschisis. The macular structures and BCVA are worst in eyes with foveal detachment.
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.
Objective To compare the efficacy of intravitreal injection of ranibizumab and bevacizumab in the treatment of pathological myopia choroidal neovascularization (PM-CNV). Methods It is a retrospective case study. Seventy-nine patients (79 eyes) with PM-CNV were enrolled in this study. There were 26 males (26 eyes) and 53 females (53 eyes), with the mean age of (30.77±5.53) years. The best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscope, fundus color photography, fundus fluorescein angiography, and optical coherence tomography (OCT) were performed. BCVA was recorded as logarithm of the minimum angle of resolution (logMAR). The central retinal thickness (CMT) was measured by OCT (Cirrus HD-OCT). The eyes were divided into bevacizumab treatment group (38 eyes) and ranibizumab treatment group (41 eyes). There was no difference of the mean logMAR BCVA, intraocular pressure and CMT between two groups (t=?0.467, ?1.983, 1.293;P=0.642, 0.051, 0.200). The eyes in bevacizumab treatment group were treated with bevacizumab 0.05 ml (1.25 mg), and the eyes in ranibizumab treatment group were treated with ranibizumab 0.05 ml (0.5 mg). Times of injection between two groups were compared. The changes of intraocular pressure were observed at 1, 7 days and 1 month after treatment. The changes of logMAR BCVA and CMT at 1, 3, 6, 12 and 24 months after treatment and systemic adverse reactions occur were compared. Results At the 1, 3, 6, 12 and 24 months after treatment, the mean logMAR BCVA of the bevacizumab treatment group and the ranibizumab treatment group was significantly improved than that before treatment (F=132.374,P＜0.01). There was no significant difference in the mean logMAR BCVA at different time points between the two groups (F=0.095,P=0.759). The mean CMT of the two groups was lower than that before treatment (F=151.653,P＜0.01). There was no significant difference in the mean CMT between the two groups (F=0.332,P=0.566). No retinal detachment, endophthalmitis, cataract and persistent high intraocular pressure were associated with drug, injection-related eye and systemic adverse events during follow-up. Seven eyes had conjunctiva bleeding after treatment, 11 patients (11 eyes) complained of shadow floaters after treatment. Conclusion Intravitreal injection of bevacizumab or ranibizumab can equally effectively improve the visual acuity and reduce the CMT of PM-CNV patients.
Objective To observe the the clinical characteristics of images of optic coherence tomography (OCT) in highly myopic eyes with retinoschisis. Methods The clincial data of 158 patients (158 eyes) with high myopia diagnosed by examinations of best corrected visual acuity and refraction, indirect stereoscopic ophthalmoloscopy, A/Bscan ultrasonography, and OCT, were retrospectively analyzed. The patients were divided into retinoschisis group and nonretinoschisis group according to the results of OCT (whether the patients had macular reinoschisis at the posterior pole). There were 53 patients (55 eyes, 34.8%) in the former group, and 101 patients (103 eyes, 65.2%) in the latter group. The age, sex, diopter, visual acuity, ocular axial length, and incidence of posterior scleral staphyloma, vitreous traction, and retinal detachment of the two groups were compared. Results B-scan ultrasonography showed posterior scleral staphloma in all of the 158 eyes. OCT indicated that in the 55 eyes in the retinnoschisis group, 15 （27.3%） had inner, 53 （96.4%）had outer, and 7 （12.7%）had middle retinoschisis. The inner and outer one could exist independently or in the same eye, while the middle one was always accompanied by the outer retinoschisis. Two or more types of schisis coexisted in 13 eyes （23.6%）, single outer retinoschisis was found in 40 eyes （72.7%）, and single inner retinoschisis was found in 2 eyes （3.6%）. There were 26 eyes（47.3%）were accompanied with retinal detachment, 13 eyes（23.6%） with macular hole, and 12 eyes （21.8%）with vitreous traction. In the 103 eyes in the nonretinoschisis group， 23 eyes （22.3%）had vitreous traction, 19 eyes （18.4%） had macular hole, and 21 eyes （20.4%）had retinal detachment. The differences of age, diopter and ocular axial length, sex, incidence of macular hole and vitreous traction between the two groups were not statistically significant (Pgt;005）. The visual acuity in retinoschisis group was much lower than that in the nonretinoschisis group （Plt;005）, and the difference of incidence of the retinal detachment between the two groups was significant (Plt;001). 〖WTHZ〗Conclusion 〖WTBZ〗Macular retinoschisis in eyes with high myopia can exist in inner or middle retina, but most of them locate at outer retina.The patients always have poor visual acuity and are often accompanied by other macular lesions such as retinal detachment.
Objective To investigate the prevalence of high myopia，the prevalence and risk factors of high myopia associated with chorioretinopathy in residents aged 60 years or over in Beixinjing community, Shanghai, China.Methods A cluster stratified random sampling method was used to screen 4153 people aged 60 and over in Beixinjing community. There were 3851participants in total with a 9273% response rate. Participants were invited to complete a questionnaire and received a comprehensive eye examination including visual acuity, refraction, slitlamp microscopic examination, direct ophthalmoscopy and fundus photography and so on. Spherical equivalent (SE) was used to determine the degree of refractive errors. The diagnosis of high myopic chorioretinopathy was made if SEgt;-6.00 D and myopic chorioretinal atrophy lesions were presented such as posterior scleral staphyloma, lacquer cracks, Fuchs spot and myopic arc spots. The degree of visual acuity impairment was determined according to the World Health Organization (WHO) classification as low vision (the best corrected visual acuity ge; 0.05, but lt;0.3) or blindness (the best corrected visual acuity lt;0.05).Results There were 207/3851(5.37%) high myopia patients, in which 183/207 (88.40%) patients were associated with myopic chorioretinopathy. The prevalence of myopic chorioretinopathy decreased while age increased (chi;2=19.21, Plt;0.01), but statistically there was no gender difference （chi;2=1.83, Pgt;0.05）. Logistic regression analysis showed that there were significant differences in the prevalence of high myopia between people with different age, educational levels and family history （chi;2=19.21，32.08，960.68；Plt;0.01）.There were 29 cases of bilateral blindness, 96 cases of unilateral blindness,104 cases of bilateral low vision and 562 cases of unilateral low vision in those participants. In 183 cases of high myopic chorioretinopathy patients, 111（60.65 %）cases had an obvious visual impairment, including 3448% (10 cases) of bilateral blindness, 1146% (11 cases) of unilateral blindness, 2981% (31 cases)of bilateral low vision and 1050% (59 cases) of unilateral low vision.Conclusions The prevalence of high myopia of residents aged ge;60 years in Beixinjing community, Shanghai,China is relatively high. Age, education level and family history are the most important factors affecting the occurrence of chorioretinopathy in high myopia patients.
ObjectiveTo evaluate the efficacy of intravitreal injections of conbercept in choroidal neovascularization (CNV) secondary to pathologic myopia (PM). MethodsA retrospective case series of 37 eyes of 37 patients affected with CNV secondary to PM treated by intravitreal injections of Conbercept. All the patients were examined with best-corrected visual acuity (BCVA) of Early Treatment Diabetic Retinopathy Study (ETDRS) chart, central macular thickness (CMT) of optical coherence tomography (OCT)at baseline. The initial average letters of ETDRS BCVA was 49.86±8.87, CMT was (306.38±31.01) μm. All eyes were treated with intravitreal Conbercept 0.05 ml (10 mg/ml). Follow-up visits were performed monthly after injection. The mean follow-up time was 16.8 months. Injections were repeated according to the situation of BCVA, CMT, subretinal fluid and CNV leakage in follow-up. All eyes received an average of 4.8 injections. BCVA, CMT and ophthalmoscope examination were assessed monthly. The relationship of BCVA improvement and CMT reduction with the data at baseline and number of treatments were analyzed by Spearman Rho correlation respectively. ResultsDuring the 1, 3, 6 and 12 months after treatment, the mean BCVA were all improved with statistically significant difference (t=17.629, P < 0.01).At 12 months, 15 eyes (45.9%) had improvement of 15 letters or more, 32 eyes (86.5%) had improvement of 5 letters or more, and 1 eye (2.7%) had decreased more than 5 letters. During the 1, 3, 6 and 12 months after treatment, the mean CMT were all decreased with statistically significant difference (F=43.726, P < 0.01). At 12 months, the retinal fluid of 34 eyes (91.9%) were absorbed completely; 33 eyes (89.2%) had angiographic closure at that time. There was no significant relevance between BCVA improvement and sex, age and course of the disease (P > 0.05), but a significant negative correlation was found between the BCVA improvement and BCVA at baseline, injection times (P < 0.05). There was no significant relevance between CMT reduction and sex, age, course of the disease and injection times (P > 0.05), but a significant positive correlation was found between CMT reduction and CMT at baseline (P < 0.05). There were no systemic or ocular serious side effects during the follow up. ConclusionsIntravitreal injections of Conbercept showed BCVA improvement and CMT reduction. It appeared to be effective and safe for choroidal neovascularization secondary to pathologic myopia. Intravitreal Conbercept for CNV secondary to PM showed BCVA improvement, CMT reduction and safety.
Macular vitreoretinal interface abnormalities in highly myopic eyes are among the most visionthreatening diseases associated with macular retinal schisis and macular holes. To relieve the traction of the posterior vitreous cortex and to recover the anatomy of fovea for good central vision are the keys to successful repair. However, there are many controversial issues in the efficacy of the surgerical procedures including gas injection, scleral buckling and vitrectomy. How to evaluate these different surgeries and to establish standard surgical procedure options for macular vitreoretinal interface abnormalities in highly myopic eyes needs to be explored.