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[Treatment of choroidal neovascularization in degenerative myopia].

Choroidal neovascularization is quite frequent in degenerative myopia. If the neovascularization is near the center, a krypton laser photocoagulation can be effected. If they reach the center, no photocoagulation should be effected. We report here our results in the treatment by krypton laser and describe a simple technic for the determination of the exact position of the foveola, that can be displaced in degenerative myopia.

Adult↗
PubMed2006

[Fundus changes evaluation in degenerative myopia].

PURPOSE: To evaluate the presence of fundus changes in degenerative myopia. METHODS: Forty patients with refractive error of at least -6.00 diopters were selected for ophthalmologic examination followed by posterior pole photograph and echobiometry. RESULTS: We studied 57 eyes of 37 patients with refractive error ranging from -6.25 to -28.50 diopters, with mean -14.05, and axial length ranging from 26.06 to 32.86 mm, with mean 28.01. We found a temporal crescent in 36.5% and a peripapillary one in 20% of the eyes. Choroidal vessels were seen in 35% of the eyes. Posterior pole changes were as follow: posterior staphyloma in 10.5%, Fuchs' spots in 3.5% and lacquer cracks in 1.5%. Peripheral retinal examination revealed paving stone chorioretinal atrophy in 17.5%, white without pressure in 10.5%, lattice degeneration in 5%, retinal tears in 3.5% and retinoschisis in 1.5% of the examined eyes. CONCLUSIONS: Fundus changes that lead to decreased vision are common in patients with degenerative myopia. Peripheral retinal examination is very important in these patients due to the increased risk of retinal detachment.

Adolescent↗
PubMed2002

[Progression of choroidal neovascularization after macular translocation in age-related macular degeneration and degenerative myopia].

PURPOSE: To study the progression of choroidal neovascularization (CNV) after macular translocation in age-related macular degeneration (AMD) and degenerative myopia. PATIENTS AND METHODS: The data from 42 consecutive eyes (28 AMD, and 14 degenerative myopia) operated on by limited macular translocation (DeJuan technique), with a follow-up of 6 months or more, were prospectively analyzed. In the AMD group, neovascularization was classic in 54% of eyes and classic and occult in 46% of eyes. Previous laser treatment was applied on extra- or juxtafoveal CNV in 3 eyes. The major outcome measures were visual acuity, fluorescein and indocyanine green angiographies. RESULTS: After translocation, foveal displacement was greater in AMD than in myopic eyes (mean: 1 260 and 812 micro m, respectively). Laser photocoagulation was applied postoperatively onto extra-or juxtafoveal CNV in 26 (93%) AMD eyes and 12 myopic eyes (86%). Mean follow-up was 10 months (range, 6-18 months). Recurrence of CNV occurred in 14 AMD eyes (50%) and 2 myopic eyes (14%) an average of 5.6 months after surgery (range, 1-18 months). Recurrence was more frequent in AMD eyes with preoperative occult CNV (66%) than without (36%). Recurrence reached the new fovea in 69% of cases. Supplementary laser treatment was possible and successful on extra- or juxtafoveal recurrence in 3 eyes. Recurrence was significantly correlated with a poor visual prognosis: eyes without recurrence or with extra- or juxtafoveal recurrence had a final gain in visual acuity of 2.4 lines, eyes with subfoveal recurrence had a loss of 1.3 lines, and eyes with diffuse recurrence had a loss of 4.2 lines. CNV appeared in a new area at a BSS injection site in one eye. Occult CNV seemed to fade relatively within the first postoperative weeks, but were unchanged at the end of follow-up. In one eye, a small polypoidal lesion near the disc noted preoperatively disappeared after surgery. CONCLUSION: Our results suggest that the surgical procedure does not affect the course of classic or occult CNV. The rate of recurrence of CNV after macular translocation seemed similar to that observed after conventional laser treatment for extrafoveal CNV in AMD. Neovascular recurrence is the most frequent postoperative complication and was frequently directed at the new fovea. Despite these complications, macular translocation moves CNV outside of the subfoveolar zone so the eyes can be treated with conventional laser, leading to a favorable outcome at the last follow-up in 57% of cases. Further studies are required to confirm these findings and to define the best criteria for treatment.

Choroid↗
PubMed2006

[Comparison of macular limited translocation and photodynamic therapy for management of choroidal neovascularization in degenerative myopia: a retrospective study].

PURPOSE: To analyze the results of limited macular translocation (MT) and photodynamic therapy (PDT) in subfoveal choroidal neovascularization due to degenerative myopia, with a minimum follow-up of 12 months. METHODS: Retrospective review of 55 consecutive patients: 31 eyes were treated using PDT and 24 were operated on with the limited macular translocation technique with chorioscleral infolding described by de Juan. Before and after each treatment, a complete examination comprised visual acuity, fundus examination, fluorescein angiography, and optical coherence tomography. Mean follow-up was 14 months in the PDT group and 19 months in the MT group. RESULTS: The improvement in visual acuity was better in the MT group than in the PDT group and was correlated with younger age (p<0.001). At month 12, visual acuity improved by 3 ETDRS lines or more in 6 six eyes of the PDT group (19%), with no improvement over 6 lines. In the MT group, visual acuity improved by 3 lines in 14 eyes (58%) including 8 eight eyes (33%) with an improvement of 6 lines or more. Final visual acuity remain unchanged (+/-2 lines) in 16 eyes of the PDT group (66%) and 8 eight eyes of the MT group (33%), and decreased in 9 nine eyes in the PDT group (29%) versus 2 two eyes in the MT group (8%). Mean gain in visual acuity at 12 months was +3.5 ETDRS lines in the MT group and -0.1 line in the PDT group (p=0.001). The mean displacement of the fovea after translocation was 950 microm. The mMean number of PDT treatments was 2.3 during the 12-month follow-up. CONCLUSIONS: Limited macular translocation allowed provided a significant improvement in visual acuity in some eyes with subfoveal neovascularization in myopia, especially in young patients, and resulted in a moderate rate of complications. Longer follow-up and further controlled and randomized studies are required to confirm these encouraging findings.

Adult↗
PubMed1996

Choroidal and retinal blood flow changes in degenerative myopia.

OBJECTIVE: To determine changes in choroidal and retinal blood flow in myopic retinopathy. DESIGN: Case-control study. SETTING: Ophthalmology department of a university-affiliated hospital in Elazig, Turkey. SUBJECTS: Twenty-one consecutive patients (40 eyes) with degenerative myopia and 20 age-matched healthy emmetropic volunteers (38 eyes). Both groups were free of any systemic disease, such as diabetes mellitus or hypertension, that can affect micro- or macrocirculation. OUTCOME MEASURES: Posterior ciliary artery and central retinal artery peak systolic, peak diastolic and mean blood flow velocity (measured with colour Doppler ultrasonography), pulsatility index and resistance index. RESULTS: The posterior ciliary artery mean peak systolic (12.34 vs. 16.90 cm/s) and peak diastolic (3.12 vs. 5.10 cm/s) blood flow velocity values were significantly lower in the study group than in the control group (p < 0.001). There was a significant difference in the posterior ciliary artery resistance index between the two groups (0.74 vs. 0.69) (p < 0.05). The central retinal artery mean peak systolic (6.64 vs. 9.72 cm/s) and peak diastolic (2.01 vs. 3.07 cm/s) blood flow velocity values were also significantly lower in the study group than in the control group (p < 0.001). CONCLUSION: Choroidal and retinal blood flow was decreased in degenerative myopia. The reduced choroidal blood flow may be partly due to increased vascular resistance. Decreased retinal blood flow is probably an adaptive change.

Adult↗
PubMed2002

Effect of peripapillary chorioretinal atrophy on GDx parametersin patients with degenerative myopia.

PURPOSE: To determine the effect of peripapillary chorioretinal atrophy in degenerative myopia on the retinal nerve fibre layer (RNFL) thickness measurements performed by scanning laser polarimetry. METHODS: Polarimetric RNFL analysis was done in 41 degenerative myopic eyes of 25 patients with spherical refractive errors between -7.50 and -22.00 D (mean -12.50 D;SD 3.5). Analysis was also performed on 46 eyes of 24 age-matched healthy subjects with spherical refractive errors between -1.00 and +1.00 D (mean -0.25 D; SD 0.50) with GDx Nerve Fiber Analyzer (Version 1.0.12). All of the myopic patients had clinically evident peripapillary chorioretinal atrophy in their fundus examination. RESULTS: In myopic patients most of the GDx parameters were statistically different from the control group (P < 0.05). Although average thickness, ellipse average, number, inferior maximum and inferior average were found to be higher than the healthy subjects,the modulation parameters and the ratio-based parameters were significantly decreased in degenerative myopic patients (P < 0.05). The TSNIT (temporal, superior, nasal, inferior, temporal) graph showed irregular high spikes with loss of the regular double hump pattern, especially in quadrants with large chorioretinal atrophy and visible sclera. CONCLUSION: Peripapillary chorioretinal atrophy increased retardation values, which might be explained by the high reflectivity of the bare sclera in these areas.

Adolescent↗
PubMed2000

[Removal of inital cataract in high degenerative myopia--selection of surgical technique and planned refractive effect].

Visual function deteriorates additionally in high degenerative myopia in consequence of initial cataract causing increase of refractive index and refractive error. This paper presents indications for removal of initial cataract with posterior chamber lens implantation to improve visual acuity, colour perception, contrast sensitivity and to broaden visual field. Particular conditions of cataract surgery in myopic eye, selection criteria of operative technique and anaesthesia, power and diameter of implant and possible postoperative complications are discussed.

Anesthesia↗
PubMed1983

The etiopathogenesis of degenerative myopia.

With reference to the most recent neurobiological and clinical research into the causes of degenerative myopia, this report is an original etiopathogenetic hypothesis for this disease.

17-Ketosteroids↗
PubMed1987

Choroidal neovascularization in degenerative myopia: role of laser photocoagulation.

Laser photocoagulation of extrafoveal choroidal new vessels was performed in 19 eyes with degenerative myopia. Sixteen eyes required only one treatment. Three eyes required more than one because of incomplete closure of the new vessels after the first treatment. Choroidal new vessel formation did not recur during the post-treatment follow-up period (average 29.2 months), and a dry, atrophic photocoagulation scar was achieved in all eyes. Visual acuity improved in only two eyes (11%), stabilized in four eyes (21%), and deteriorated in 13 eyes (68%). All except two eyes showed spontaneous progressive enlargement of the atrophic photocoagulation scar, which worsened visual acuity in 13 eyes (68%).

Adult↗
PubMed2001

[Study of subretinal neovascular membranes secondary to degenerative myopia].

PURPOSE: To study the type, size, location and posterior time evolution of the subretinal neovascular membranes (SRNM) secondary to degenerative myopia (DM) and its relationship with the degree of myopic ametropia. METHODS: We studied 65 patients (130 eyes) with MD who were divided into three groups according to their refraction. A complete ophthalmologic examination, including a fluorescein angiography (FAG), was performed for all the patients. Based on this test, 55 SRNA were identified, and were classified into two types according to the fluorescein angiography results. Their position was described in relationship to the foveal avascular zone (FAZ) and their size was measured. RESULTS: 55 (42.3%) of the 130 eyes presented SRNM, which was bilateral in 16.32% of the patients. Based on the FAG criteria, 41 eyes (74.54%) presented type 1 SRNM, 60% (33 eyes) presented subfoveal membranes and the size was greater than 1,500 microns in more than 75%. The development of the SRNM showed no relationship with the myopic ametropia degree (P<0.2500). The follow-up time was 24.61+/-7.63. CONCLUSIONS: No relationship between the appearance of the development of the SRNM and the myopia degree has been found. These are generally small sized, have poor dye diffusion and are frequently located in the foveal zone. The visual acuity loss is often sudden and maintained over time.

Adult↗
PubMed2001

Translocation of the macula for management of subfoveal choroidal neovascularization: comparison of results in age-related macular degeneration and degenerative myopia.

PURPOSE: To report the results of limited macular translocation in subfoveal choroidal neovascularization resulting from age-related macular degeneration or degenerative myopia. METHODS: The first consecutive 32 patients (23 age-related macular degeneration eyes and nine myopic eyes) were operated on with the limited macular translocation technique described by de Juan. Before and after surgery, a complete examination included fluorescein and indocyanine-green angiographies and optical coherence tomography. Mean follow-up was 9 months in the age-related macular degeneration group (range, 6 to 14 months) and 10 months in the myopic group (range, 6 to 15 months). RESULTS: The improvement in visual acuity was better in the myopic group than in the age-related macular degeneration group and was correlated with younger age in the myopic group (P <.05). At the end of follow-up, visual acuity improved by 2 lines or more in seven age-related macular degeneration eyes (30%), including four eyes (13%) with an improvement of 6 lines or more, and in six myopic eyes (67%), including two eyes (22%) with an improvement of 6 lines or more. Final visual acuity was unchanged in four age-related macular degeneration eyes (17%) and three myopic eyes (33%), and decreased in 12 age-related macular degeneration eyes (52%). Conversely, the mean foveal displacement was greater in age-related macular degeneration than in myopia (1,105 microm and 685 microm, respectively; P <.05). Main complications were retinal detachment (six eyes), neovascularization at the injection site (two eyes), and recurrence of neovascularization (43% of the age-related macular degeneration group and 11% of the myopic group). CONCLUSIONS: Limited macular translocation allowed a significant improvement in visual acuity in some eyes with subfoveal neovascularization and resulted in a moderate rate of complications. Longer follow-up and additional studies are required to confirm these findings.

Adult↗
PubMed1986

Familial sinus node disease and degenerative myopia--a new hereditary syndrome?

A family is reported in which the father and both offspring suffered from sick sinus syndrome (SSS) accompanied by degenerative myopia in the two elder of the three family members. In all three individuals, the basic manifestations of the SSS were total sinus arrest with secondary AV junctional rhythm at a normal rate. Only the 7-year-old boy also exhibited paroxysmal atrial flutter and ventricular asystole lasting up to almost 7 s. Since he had, furthermore, recently sustained a left hemiparesis, a ventricular demand pacemaker was implanted. Chronic atrial fibrillation was eventually established in the father in whom observations were available for 16 years. Myopia of -11 D and -4.5 D, respectively, existed in the father and his 14-year-old daughter. The familial association of this defect with SSS suggests a hitherto undescribed genetic syndrome, presumably with underlying autosomal dominant transmission of the two traits.

Adolescent↗
PubMed1984

Natural history of choroidal neovascularization in degenerative myopia.

We studied 354 eyes with myopic chorioretinal degeneration by means of standard clinical evaluation and fluorescein angiography. The eyes were classified on the basis of the degree of chorioretinal degeneration found in the posterior pole. Lacquer cracks (breaks in Bruch's membrane) were noted in 82% of the 149 eyes with choroidal neovascular membranes (CNM) and in 96% of the 58 eyes with isolated subretinal hemorrhages. These hemorrhages were reabsorbed without adverse visual sequelae in 32 eyes that were followed; in 14 of these eyes that were followed closely, the average time of reabsorption was 6.4 weeks. Seventy eyes with CNM were followed for an average of 40.9 months. In 96% of these eyes the CNM remained stable or regressed, leaving an atrophic, nonexudative scar. This study indicates that CNM in degenerative myopia is usually self-limited.

Adolescent↗