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Cheung CMG, Arnold JJ, Holz FG, Park KH, Lai TY, Larsen M, Mitchell P, Ohno-Matsui K, Chen SJ, Wolf S, Wong TY. Myopic Choroidal Neovascularization. Ophthalmology 2017; 124:1690-1711. [DOI: 10.1016/j.ophtha.2017.04.028] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 04/03/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023] Open
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Ho M, Liu DTL, Young AL, Lam DSC. Management of Choroidal Neovascularization Secondary to Pathological Myopia: The Era of Changes. Asia Pac J Ophthalmol (Phila) 2014; 3:94-103. [PMID: 26107492 DOI: 10.1097/apo.0000000000000017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Choroidal neovascularization (CNV) secondary to pathological myopia is an important cause of significant visual impairment in young adults. High myopia is particularly prevalent in Asian population. New scientific contributions have been made to the understanding of high myopia and myopic CNV. Treatment for myopic CNV has previously relied on photodynamic therapy, laser photocoagulation, and submacular surgery. The treatment outcomes from these modalities are, however, controversial. The introduction of antiangiogenic agents including bevacizumab and ranibizumab has brought the treatment of myopic CNV into a new era. The purpose of this review was to provide an overview of the natural history of myopic CNV, the prognostic factors, and the various treatment options including laser photocoagulation and photodynamic therapy, with particular attention on antiangiogenic agents.
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Affiliation(s)
- Mary Ho
- From the *Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China; and †Dennis Lam and Partners Eye Center, Central Building, Central, Hong Kong, People's Republic of China
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Soubrane G. Choroidal Neovascularization in Pathologic Myopia: Recent Developments in Diagnosis and Treatment. Surv Ophthalmol 2008; 53:121-38. [DOI: 10.1016/j.survophthal.2007.12.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nguyen NX, Besch D, Bartz-Schmidt K, Gelisken F, Trauzettel-Klosinski S. Reading performance with low-vision aids and vision-related quality of life after macular translocation surgery in patients with age-related macular degeneration. ACTA ACUST UNITED AC 2007; 85:877-82. [PMID: 17651462 DOI: 10.1111/j.1600-0420.2007.00963.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the power of magnification required, reading performance with low-vision aids and vision-related quality of life with reference to reading ability and ability to carry out day-to-day activities in patients after macular translocation. METHODS This study included 15 patients who had undergone macular translocation with 360-degree peripheral retinectomy. The mean length of follow-up was 19.2 +/- 10.8 months (median 11 months). At the final examination, the impact of visual impairment on reading ability and quality of life was assessed according to a modified 9-item questionnaire in conjunction with a comprehensive clinical examination, which included assessment of best corrected visual acuity (BCVA), the magnification power required for reading, use of low-vision aids and reading speed. Patients rated the extent to which low vision restricted their ability to read and participate in other activities that affect quality of life. Responses were scored on a scale of 1.0 (optimum self-evaluation) to 5.0 (very poor). RESULTS In the operated eye, overall mean postoperative BCVA (distance) was not significantly better than mean preoperative BCVA (0.11 +/- 0.06 and 0.15 +/- 0.08, respectively; p = 0.53). However, 53% of patients reported a subjective increase in visual function after treatment. At the final visit, the mean magnification required was x 7.7 +/- 6.7. A total of 60% of patients needed optical magnifiers for reading and in 40% of patients closed-circuit TV systems were necessary. All patients were able to read newspaper print using adapted low-vision aids at a mean reading speed of 71 +/- 40 words per minute. Mean self-reported scores were 3.2 +/- 1.1 for reading, 2.5 +/- 0.7 for day-to-day activities and 2.7 +/- 3.0 for outdoor walking and using steps or stairs. Patients' levels of dependency were significantly correlated with scores for reading (p = 0.01), day-to-day activities (p < 0.001) and outdoor walking and using steps (p = 0.001). CONCLUSIONS The evaluation of self-reported visual function and vision-related quality of life in patients after macular translocation is necessary to obtain detailed information on treatment effects. Our results indicated improvement in patients' subjective evaluations of visual function, without significant improvement in visual acuity. The postoperative clinical benefits of treatment coincide with subjective benefits in terms of reading ability, quality of life and patient satisfaction. Our study confirms the importance and efficiency of visual rehabilitation with aids for low vision after surgery.
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Affiliation(s)
- Nhung X Nguyen
- Department of Ophthalmology II, University Eye Hospital, Tübingen, Germany.
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Chan WM, Ohji M, Lai TYY, Liu DTL, Tano Y, Lam DSC. Choroidal neovascularisation in pathological myopia: an update in management. Br J Ophthalmol 2005; 89:1522-8. [PMID: 16234465 PMCID: PMC1772951 DOI: 10.1136/bjo.2005.074716] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Choroidal neovascularisation (CNV) secondary to pathological myopia is an important cause of significant visual impairment in young and middle aged adults globally and is particularly prevalent in Asian populations. In the past few years, there have been rapid advancements in the different treatments for myopic CNV. The purpose of this perspective is to give an overview of the natural history of myopic CNV and the various treatment options including laser photocoagulation, photodynamic therapy, sub-macular surgery, and macular translocation surgery. Future directions in the management of myopic CNV are also discussed.
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Affiliation(s)
- W-M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 3/F, Hong Kong Eye Hospital, Kowloon, Hong Kong.
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Mateo C, Moreno J, Rosales G, Lechuga M, Castillo R, Vaz F, Corcóstegui B. Two-year results of macular translocation with scleral infolding in myopic choroidal neovascularisation. Semin Ophthalmol 2005; 19:29-42. [PMID: 15590532 DOI: 10.1080/08820530490520013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To assess the two year outcome following macular translocation (MT) with scleral infolding in the management of myopic subfoveal choroidal neovascularisation (CNV). DESIGN Prospective, clinical interventional noncomparative consecutive case series. PARTICIPANTS 79 eyes of 79 patients with myopic subfoveal CNV and less than 6 months of duration of the symptoms. INTERVENTION MT with scleral infolding. MAIN OUTCOME MEASURES Visual Acuity (VA), reading ability of 12 point Arial letter sentences at a reading distance without magnifying systems and foveal displacement. RESULTS Mean preoperative VA was 20/125, after two years the mean VA was 20/80. Reading ability of 12 point Arial letter sentences at a reading distance (33 cm) was obtained in 59% of the eyes at one year, descending to 43% at two years. Mean foveal displacement after surgery was 942 microns. Intraoperative complications have been: retinal breaks (21.5%) and choroidal haemorrhage not affecting the posterior pole (3.7%). Main postoperative complications have been: Insufficient foveal displacement: 20%; Retinal detachment: 8.8%; Subfoveal recurrence: 28%; macular fold: 2.5% and macular hole: 1.2%. CONCLUSION MT with scleral infolding offers the opportunity to recover central vision and reading ability in patients with myopic CNV but it remains unpredictable.
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Affiliation(s)
- Carlos Mateo
- Instituto de Microcirugía Ocular, Universidad Autónoma de Barcelona, Barcelona, Spain.
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Oyagi T, Fujikado T, Hosohata J, Ohji M, Kamei M, Bessho K, Tano Y. FOVEAL SENSITIVITY AND FIXATION STABILITY BEFORE AND AFTER MACULAR TRANSLOCATION WITH 360-DEGREE RETINOTOMY. Retina 2004; 24:548-55. [PMID: 15300075 DOI: 10.1097/00006982-200408000-00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the functional changes of the fovea by scanning laser ophthalmoscopy (SLO) fundus perimetry after macular translocation with 360-degree retinotomy, and to determine whether the preoperative macular function estimated by the sensitivity of the fovea and the stability of fixation can predict visual acuity after the surgery. METHODS Macular translocation with 360-degree retinotomy and simultaneous torsional muscle surgery were performed on 25 eyes of 25 patients with choroidal neovascularization. The index of foveal sensitivity (Isens) and the index of fixation stability (Ifix) before and after surgery were calculated from the microperimetric data. The preoperative Isens and Ifix were compared with postoperative Isens and Ifix, respectively. The correlations of preoperative Isens and Ifix with the visual acuity after the translocation surgery (VApost) were calculated. RESULTS Isens increased in 14 (56%) of 25 eyes. Ifix improved in 10 (40%) of 25 eyes. The preoperative Isens and VApost were moderately correlated (r = 0.434, P = 0.0295), while the preoperative Ifix and VApost were highly correlated (r = - 0.530, P = 0.0057). CONCLUSION An increase in foveal sensitivity and an improvement in the fixation stability were demonstrated quantitatively by microperimetry. The preoperative foveal sensitivity and fixation stability were correlated with the postoperative visual acuity. Microperimetry using SLO can be used to investigate foveal function before and after the translocation and to predict the postoperative visual acuity.
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Affiliation(s)
- Tomohito Oyagi
- Department of Ophthalmology, Osaka Rosai Hospital, Osaka University Medical School, Japan.
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Abstract
PURPOSE OF REVIEW Choroidal neovascularization (CNV) is the most common vision-threatening complication of high myopia. Myopic CNV has recently attracted a lot of attention, mainly because of a variety of newly developed treatments. To evaluate the efficacy of these new treatments against myopic CNV, we need to know more precisely the natural course of myopic CNV. The results of most previously reported studies regarding the natural course of myopic CNV, however, are somewhat contradictory. In this review, we describe the recently reported long-term prognosis of myopic CNV and the effectiveness of newly developed treatments as well as an overview of possible future treatments. RECENT FINDINGS A recent study evaluating the visual outcome of myopic CNV for at least 10 years after onset in a large series of patients reported that the visual prognosis of myopic CNV without treatment is extremely poor, mainly because of the secondary development of chorioretinal atrophy around the area of regressed CNV. Although conventional treatments against myopic CNV, such as laser photocoagulation or surgical extraction of CNV, have not been effective, newly developed treatments such as foveal translocation or photodynamic therapy have had favorable results on myopic CNV in the short-term. Pharmacologic interventions to treat or prevent CNV are also expected in the future. SUMMARY Because the natural prognosis of myopic CNV is extremely poor, treatment to prevent further visual loss is necessary. Based on the steady and gradual visual decrease in myopic CNV over the long term, however, long-term results are needed before the true effectiveness of the newly developed active treatments can be determined.
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Affiliation(s)
- Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Fujikado T, Asonuma S, Ohji M, Kusaka S, Hayashi A, Ikuno Y, Kamei M, Oda K, Tano Y. Reading ability after macular translocation surgery with 360-degree retinotomy. Am J Ophthalmol 2002; 134:849-56. [PMID: 12470753 DOI: 10.1016/s0002-9394(02)01756-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report reading ability using a standardized reading chart after macular translocation with 360-degree retinotomy in eyes with age-related macular degeneration (AMD) or with myopic choroidal neovascularization (mCNV). DESIGN Interventional case series. METHODS In 34 eyes of 34 patients with subfoveal choroidal neovascular membrane (AMD, 23; mCNV, 11), macular translocation surgery with 360-degree retinotomy and simultaneous extraocular muscle surgery were performed. The average age was 67.4 +/- 7.9 years, and the average follow-up period was 7.6 +/- 3.3 months. The best-corrected far visual acuity (FVA) was measured with a standardized visual acuity chart using Landolt Cs, and the critical print size (CPS) was determined with the Japanese version of the Minnesota reading chart (MNREAD-J Chart) preoperatively and postoperatively. Preoperative and postoperative change in the CPS was compared with the subjective visual improvement as assessed by a questionnaire. RESULTS The postoperative improvement of FVA was statistically significant in eyes with mCNV (P =.010) but not significant in eyes with AMD (P =.495). The postoperative improvement of CPS was statistically significant both in eyes with AMD (P =.027) and in eyes with mCNV (P =.004). The subjective visual improvement was significantly correlated with the change of CPS in patients after a second better eye surgery. CONCLUSIONS After macular translocation with 360-degree retinotomy, the improvement of reading ability was significant in eyes with both AMD and mCNV. We conclude that this surgical method is well suited to improve reading ability of patients with AMD or mCNV.
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Affiliation(s)
- Takashi Fujikado
- Department of Visual Science, Osaka University Medical School, Osaka, Japan.
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Richter-Mueksch S, Weghaupt H, Skorpik C, Velikay-Parel M, Radner W. Reading performance with a refractive multifocal and a diffractive bifocal intraocular lens. J Cataract Refract Surg 2002; 28:1957-63. [PMID: 12457669 DOI: 10.1016/s0886-3350(02)01488-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the reading performance of a diffractive bifocal (811E, Pharmacia) and a refractive multifocal (SA40N, Allergan) intraocular lens (IOL) and compare it with that of a monofocal IOL (811C, Pharmacia) with respect to reading acuity, reading speed based on print size, maximum reading speed, reading distance, and critical print size. SETTING Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS This study comprised 120 pseudophakic eyes of 70 patients; each IOL group had 40 eyes. The patients' age, sex, and best corrected logMAR visual acuity were recorded. Reading acuity and speed were tested monocularly. Reading acuity was determined in logRAD (ie, the reading equivalent of logMAR). Patients with bifocal and multifocal IOLs read with best distance correction and patients with a monofocal IOL, with an addition of +3.0 diopters. RESULTS The age, mean spherical equivalent, cylinder, and best corrected distance visual acuity were comparable among the 3 groups. The mean logRAD reading acuity was 0.17 +/- 0.18 (SD) in the 811E group (94.0% of logMAR), 0.31 +/- 0.13 in the SA40N group (73.2% of logMAR), and 0.24 +/- 0.22 in the 811C group (94.1% of logMAR). The reading acuity in the SA40N group was statistically significantly lower than in the 811E and 811C groups. The best reading distance was 30 cm in the 811E group and 40 cm in the SA40N group. The mean maximum reading speeds in words per minute were comparable: 187.5 +/- 26.1 (811E), 171.0 +/- 21.1 (SA40N), and 179.4 +/- 21.6 (811C). The reading speed, which ranged from logRAD 0.7 to 0.3, and the critical print size in the SA40N group were significantly worse than in the 811E and 811C groups. The mean critical print size in the 811E group was significantly worse than in the 811C group. CONCLUSIONS Reading performance was acceptable in the bifocal and multifocal IOL patients, with the diffractive bifocal IOL performing best in a standardized reading test setting.
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Abstract
PURPOSE To describe current concepts and available treatments for pathologic myopia. DESIGN Review of experimental and clinical studies. METHODS The demography, natural history, medical and surgical treatments for choroidal neovascular membrane, vitreoretinal interface disorders and future strategies for pathologic myopia are reviewed. RESULTS Several medical and surgical modalities are currently available to treat various complications of pathologic myopia. Macular translocation appears to stabilize or improve visual function in many eyes with choroidal neovascularization. CONCLUSION Newer strategies are emerging to better ameliorate or prevent the complications of pathologic myopia.
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Affiliation(s)
- Yasuo Tano
- Department of Ophthalmology, Osaka University, Medical School, Osaka, Japan.
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Fujikado T, Ohji M, Kusaka S, Hayashi A, Kamei M, Okada AA, Oda K, Tano Y. Visual function after foveal translocation with 360-degree retinotomy and simultaneous torsional muscle surgery in patients with myopic neovascular maculopathy. Am J Ophthalmol 2001; 131:101-10. [PMID: 11162984 DOI: 10.1016/s0002-9394(00)00770-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess functional and anatomical outcomes after foveal translocation with 360-degree retinotomy and simultaneous torsional muscle surgery in patients with myopic neovascular maculopathy. METHODS Foveal translocation with 360-degree retinotomy was performed in 11 eyes of 11 patients with myopic neovascular maculopathy. Ten eyes had simultaneous torsional muscle surgery with recession of the superior oblique muscle and tucking of the inferior oblique muscle. Silicone oil removal with or without intraocular lens implantation was performed 2 to 8 weeks after the primary procedure. Visual acuity, binocular function, and degree of cyclotorsion were assessed preoperatively and postoperatively. Angles of retinal and globe rotation, distance of foveal shift, and surgical complications were also investigated. RESULTS With a mean postoperative follow-up of 6.2 months (range, 3 to 13 months), vision improved (greater than 0.2 logarithm of minimal angle of resolution [logMAR] units) in eight eyes, was unchanged in two eyes, and worsened (greater than 0.2 logMAR units) in 1 eye. Seven of 11 eyes (64%) had a final visual acuity of 20/50 or better. Five patients developed or maintained binocular fusion, four patients continued to have suppression, and two patients developed diplopia that was managed by spectacles with Fresnel prisms. Subjective cyclotorsion was less than 8 degrees in 10 eyes. Mean retinal and globe rotations were 23.4 degrees and 19.8 degrees, respectively. Average size of the choroidal neovascular membrane was 0.8 disk diameter, whereas the average distance of foveal shift was 1.5 disk diameter. After the primary procedure, three eyes developed retinal detachment, one eye macular hole, and one eye proliferative vitreoretinopathy. These complications were successfully managed by additional surgery. CONCLUSION Foveal translocation with 360-degree retinotomy is effective in restoring vision in some patients with myopic neovascular maculopathy. Although the development of torsional diplopia is generally obviated by simultaneous extraocular muscle surgery, a relatively high incidence of surgical complications should be taken into account with this procedure.
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Affiliation(s)
- T Fujikado
- Department of Ophthalmology, Osaka University Medical School, Osaka, Japan.
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