1/10. Early neovascular bridging after photodynamic therapy of myopic choroidal neovascularization. BACKGROUND: Photodynamic therapy is a relatively new modality for the treatment of subfoveal choroidal neovascularization (CNV). An unusual response to verteporfin therapy of myopic CNVs is reported. methods: Out of 187 CNVs secondary to pathologic myopia treated with photodynamic therapy, three eyes manifested two separate foci of CNV before treatment. The three eyes were treated with verteporfin therapy according to the standard protocol, using a single spot of light that covered both neovascular fronds. RESULTS: All the three eyes showed neovascular bridging of the two separate neovascular complexes 1 month after treatment. CONCLUSIONS: Eyes with multiple foci of myopic CNV may show unexpected outcomes after verteporfin therapy. Several factors, such as changes of the retinal pigment epithelium and choroidal vasculature involved in the treatment and enhanced expression of vascular endothelial growth factor, may play a role. ( info) |
2/10. Verteporfin photodynamic therapy for extrafoveal choroidal neovascularisation in pathologic myopia. BACKGROUND: To report long-term functional and morphological outcome of verteporfin photodynamic therapy (PDT) for classic extrafoveal choroidal neovascularisation (CNV) secondary to pathologic myopia. methods: This retrospective case series included three eyes of three consecutive patients with classic extrafoveal CNV secondary to pathologic myopia, who underwent PDT at a tertiary retinal referral centre. Change in visual acuity and fluorescein leakage was the main outcome criteria. RESULTS: The patients were followed up an average of 36 months (33-40 months). In all eyes increase of visual acuity (one eye 1 ETDRS line, two eyes 2 ETDRS line) and no fluorescein leakage of the CNV were seen. CONCLUSIONS: PDT can achieve long-term improvement of the visual acuity and morphological stability in selected cases with classic extrafoveal CNV in pathologic myopia. Large scale randomised studies are warranted for assessment of the benefit of PDT in such eyes. ( info) |
3/10. Initial experience of macular translocation in singapore - one-year results. INTRODUCTION: This paper reports the 1-year results of the first 2 cases of macular translocation in singapore. CLINICAL PICTURE: A 66-year-old female and a 45-year-old male Chinese presented with subfoveal choroidal neovascularisation (CNV) in their right eyes. The woman's condition was secondary to pathological myopia while the man's was idiopathic. Their preoperative best-corrected visual acuities were 6/15-2 and 6/30, respectively. TREATMENT: Both patients underwent macular translocation with punctate retinotomies and chorioscleral infolding (limited macular translocation) in their affected eye. OUTCOME: Both patients achieved effective macular translocation postoperatively. Their CNVs became extrafoveal and were ablated with conventional laser photocoagulation in the early postoperative period. They did not recur and their visual acuities improved to 6/9-1 and 6/12 at 1 year postoperatively, respectively. CONCLUSION: Macular translocation is a new treatment modality that offers patients with subfoveal CNV a chance of improving their vision, potentially to a level that may allow reading and driving. ( info) |
4/10. Peculiar arcuate scotoma in pathologic myopia--optical coherence tomography to detect peripapillary neural tissue loss over the disc crescent. BACKGROUND: Optical coherence tomography (OCT) was used to detect peripapillary neural tissue loss (PPNTL) over the disc crescent in pathologic myopia. The retinal neural tissue loss located inside the disc crescent in pathologic myopia is a newly recognized fundus lesion. methods: review of ten eyes of ten patients with peripapillary yellowish-white retinal lesions who underwent OCT for evaluation of the nature of PPNTL in pathologic myopia. OCT, fluorescein angiography, automated visual fields, axial length measurement with ultrasound A scan, and ultrasound B scan were performed. RESULTS: Ten eyes of ten patients were identified during a 14-year period to have findings characteristic of PPNTL. The mean age of the patients was 46 years. They were followed up for an average of 9 years. The mean spherical equivalent correction was -10.50 diopters (D) (range -6.0--16.0 D). The mean axial length was 28.6 mm (range 26.30-31.50 mm). In each case, OCT showed a complete retinal discontinuity in the PPNTL lesion. Automated visual field examination showed corresponding arcuate scotoma. During the follow-up period, the inner retina layer of the retinal defect margin was elevated by posterior hyaloid and partial retinal detachment developed in one eye. CONCLUSIONS: PPNTL in pathologic myopia is a relatively asymptomatic, yellowish-white peripapillary retinal discontinuity. Recognition of this lesion is important because the visual field defect may mimic glaucomatous changes owing to the loss of nerve fiber layer. Progressive partial retinal detachment may ensue as one of the complications of the peripapillary lesion. ( info) |
5/10. Episcleral macular buckling by semirigid shaped-rod exoplant for recurrent retinal detachment with macular hole in highly myopic eyes. PURPOSE: To evaluate the effects of episcleral macular buckling in highly myopic eyes with postvitrectomy recurrent retinal detachment with macular hole. DESIGN: Interventional case study. methods: Episcleral macular buckling with a shaped-rod silicone plastic exoplant, facilitated by episcleral tissue removal and intraocular pressure reduction, was performed at tokyo Medical University Hospital for postvitrectomy recurrent retinal detachment due to macular hole in three highly myopic eyes with axial length of >27 mm. RESULTS: Optical coherence tomography showed successful retinal reattachment after the buckling procedure in all three eyes and closure of the macular hole in two of the three, and visual acuity improved to 20/200, 20/200, and 20/63 from preoperative values of 20/320, 20/250, and 20/320, respectively. CONCLUSIONS: The anatomic and functional results of the macular buckling procedure used in these three cases were favorable, suggesting that this procedure can provide an effective means of retinal reattachment particularly in cases of retinal detachment recurrence after vitrectomy and therefore warrants further study. ( info) |
6/10. Peripapillary intrachoroidal cavitation in myopia. PURPOSE: To report optical coherence tomography (OCT) findings in disorders recently described as peripapillary detachment in pathologic myopia (PDPM). DESIGN: Observational case report. methods: OCT, fluorescein, and indocyanine green angiography. RESULTS: A 69-year-old woman presented with bilateral yellow-orange peripapillary area at the inferior border of the myopic conus, typical of PDPM. OCT showed this area as a large intrachoroidal hyporeflective space located below the normal plane of the retinal pigment epithelium. There was no detachment of the retinal pigment epithelium which appeared flat. CONCLUSIONS: OCT findings suggest calling this anomaly peripapillary intrachoroidal cavitation, instead of peripapillary detachment in pathologic myopia. ( info) |
7/10. Characteristics of peripapillary detachment in pathologic myopia. OBJECTIVE: To evaluate the prevalence and clinical features of a newly recognized peripapillary lesion specific to high myopia, peripapillary detachment in pathologic myopia (PDPM), in a large series of patients with high myopia. methods: Three hundred twenty-four patients (632 eyes) with high myopia were enrolled in this study. We examined the prevalence, range, fluorescein and indocyanine green angiographic findings, and optical coherence tomography findings of PDPM for these patients. Visual field testing (Goldmann kinetic perimetry and the Humphrey 30-2 program) was also performed in the patients with PDPM. RESULTS: Peripapillary detachment in pathologic myopia was identified in 31 of 632 highly myopic eyes (4.9%). The optical coherence tomographic scan across the PDPM lesion revealed a localized detachment of retinal pigment epithelium adjacent to the optic nerve. Although PDPM was always situated adjacent to the inferior edge of the optic disc, in some patients it surrounded almost the entire optic disc. There was a steep excavation of the inferior myopic conus adjacent to the PDPM, and the inferotemporal retinal vein was markedly bent at the transition from the PDPM to the excavated myopic conus. Glaucomatous visual field defects were frequently detected in eyes with PDPM (71.0%). CONCLUSIONS: The findings of this study indicate that PDPM is not uncommon among highly myopic eyes. Although its pathogenesis and pathologic significance require further classification, PDPM might be another indicator of visual field defects in high myopia. ( info) |
8/10. vitrectomy for myopic posterior retinoschisis or foveal detachment. PURPOSE: To evaluate the efficacy of vitrectomy for posterior retinoschisis (RS) or foveal detachment (FD) associated with posterior staphyloma in myopic eyes. methods: We reviewed the records of 14 consecutive patients (53-77 years of age; 16 eyes) with progressive visual impairment as a result of myopic RS or FD. Optical coherence tomography demonstrated the presence of a variety of RS and FD characteristics. Five eyes had RS alone, and 11 eyes had RS and FD. Two eyes with RS and severe FD developed retinal detachment in conjunction with a tiny macular hole. vitrectomy, including posterior vitreous separation in all eyes and internal limiting membrane (ILM) peeling in six eyes, had been performed. The patients were followed postoperatively for 6 to 66 months (mean, 24 months). The anatomical outcome and visual acuity were retrospectively analyzed in this study. RESULTS: Although the two eyes with RS and severe FD developed retinal detachment with a macular hole after an initial vitrectomy, final retinal reattachment was achieved in all 16 eyes. visual acuity improved in nine eyes and remained unchanged in seven eyes. CONCLUSIONS: vitrectomy with posterior vitreous separation is effective for reattaching the macula and preventing a deterioration of vision, although eyes with RS and severe FD may be at risk for the development of a macular hole after the initial vitrectomy. ( info) |
9/10. reoperation for persistent myopic foveoschisis after primary vitrectomy. PURPOSE: We performed vitrectomy on two eyes for persistent myopic foveoschisis (MF) after primary surgery that did not include internal limiting membrane (ILM) peeling. DESIGN: Interventional case reports. methods: Two highly myopic eyes of two patients with persistent MF after primary vitrectomy and gas tamponade but without ILM peeling were treated with pars plana vitrectomy, residual vitreous cortex removal, ILM peeling, and long-term gas tamponade. RESULTS: Total foveal reattachment was achieved and best-corrected visual acuity (BCVA) improved in both eyes. CONCLUSIONS: reoperation including complete vitreous cortex removal and ILM peeling could be beneficial for patients with persistent MF after primary surgery, indicating that vitreous cortex removal and ILM peeling are critical in treating MF. ( info) |
10/10. Fixed, dilated pupil after phakic intraocular lens implantation. A 26-year-old man with degenerative high myopia had bilateral anterior chamber phakic intraocular lens (IOL) implantation under general anesthesia. The preoperative slitlamp examination was normal. No mydriatic drops were used before, during, or after the procedure. Postoperatively, the intraocular pressure (IOP) in the right globe increased to 60 mm Hg. After the IOP was controlled, the pupil became fixed and dilated. iris fluorescein angiography was obtained and delayed filling of the iris capillary plexus with large areas of no perfusion was observed in the right eye. Based on these findings, a diagnosis of Urrets-Zavalia syndrome was made. To our knowledge, this is the first report of Urrets-Zavalia syndrome after phakic IOL implantation. ( info) |