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Iatrogenic diplopia [corrected]. Int Ophthalmol 2014; 34:1007-24. [PMID: 24604420 DOI: 10.1007/s10792-014-9927-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 02/26/2014] [Indexed: 10/25/2022]
Abstract
Diplopia is a very disturbing condition that has been reported as a complication of several surgical procedures. The following review aims to identify the ocular and nonocular surgical techniques more often associated with this undesirable result. Diplopia is reported as an adverse outcome of some neurosurgical procedures, dental procedures, endoscopic paranasal sinus surgery, and several ophthalmic procedures. The most common patterns and some recommendations in order to prevent and treat this frustrating outcome are also given.
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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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Neelam K, Cheung CMG, Ohno-Matsui K, Lai TYY, Wong TY. Choroidal neovascularization in pathological myopia. Prog Retin Eye Res 2012; 31:495-525. [PMID: 22569156 DOI: 10.1016/j.preteyeres.2012.04.001] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 04/13/2012] [Accepted: 04/16/2012] [Indexed: 12/21/2022]
Abstract
Myopic choroidal neovascularization (CNV) is one of the leading causes of visual impairment worldwide. The clinical and socioeconomic impact of myopic CNV in Asian countries is particularly significant due to rising trend in the prevalence and severity of pathological myopia. The exact pathogenesis of myopic CNV remains unclear and there is paucity of information with respect to incidence and risk factors for myopic CNV from prospective studies. Furthermore, there are no recognized measures that may prevent or delay the development of CNV in eyes with pathological myopia. Advances have been made in the diagnosis and characterization of myopic CNV over the years. Until recently, treatment modalities for myopic CNV were limited to thermal laser photocoagulation and photodynamic therapy with verteporfin, both these modalities primarily aim at prevention of further visual loss. In the last 5 years, inhibitors of vascular endothelial growth factor (VEGF) have been used successfully and may improve vision to some extent. Nevertheless, the long-term safety and efficacy of anti-VEGF agents remains unknown. Furthermore, the risk of developing chorioretinal atrophy remains the key factor in determining the final visual outcome. This review article summarizes the current literature on myopic CNV, highlighting new evolving diagnostic and treatment modalities, prognostic factors influencing visual outcome, and areas of future research.
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Affiliation(s)
- Kumari Neelam
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
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Ryu JW, Cho HK, Lee WK. Short-Term Effect of Intravitreal Bevacizumab Injection for Choroidal Neovascularization Associated With Degenerative Myopia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.9.1334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jeong-Wan Ryu
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Kyung Cho
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won-Ki Lee
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Glacet-Bernard A, Benyelles N, Dumas S, Haddad WM, Voigt M, Razavi S, Roquet W, Coscas G, Soubrane G. Photodynamic therapy vs limited macular translocation in the management of subfoveal choroidal neovascularization in pathologic myopia: a two-year study. Am J Ophthalmol 2007; 143:68-76. [PMID: 17188042 DOI: 10.1016/j.ajo.2006.09.041] [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] [Received: 12/20/2005] [Revised: 07/17/2006] [Accepted: 09/14/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare the results of limited macular translocation and photodynamic therapy (PDT) in subfoveal choroidal neovascularization (CNV) attributable to pathologic myopia with a 24-month follow-up. DESIGN Retrospective analysis of nonrandomized interventional clinical study. METHODS Retrospective review of 66 consecutive patients: 34 myopic eyes with subfoveal neovascularization treated by PDT and 32 operated on with the translocation technique. Translocation was considered principally when the lesion size was adequate (nasal inferior margin of the membrane less than half a disk diameter away from the center of the fovea) with duration of symptoms of less than four months. Main outcome measure was the postoperative change in visual acuity. RESULTS In the translocation group, mean gain in visual acuity was greater than in the PDT group (+2.8 lines and -1.8 line, respectively, P = .001). In the translocation group, 55% of eyes gained 3 lines or more at two years compared with 10% in the PDT group. Sixty percent of eyes in the translocation group vs 40% in the PDT group had an improvement of at least five letters. Mean foveal displacement after translocation was 906 mum; postoperative complications included retinal detachment (three eyes), macular fold (one eye), and transient diplopia (four eyes). In young patients, the postoperative gain was better in both groups. In the translocation group, mean survival time for choroidal neovascularization recurrence was 40 months for patients younger than 40 years and 20 months for older patients. CONCLUSIONS Translocation showed better results than PDT at two years. Further studies are required to confirm these findings.
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Affiliation(s)
- Agnès Glacet-Bernard
- University Eye Clinic of Créteil, Intercommunal and Henri Mondor (Assistance Publique des Hôpitaux de Paris) Hospitals, University of Paris XII, 40 Avenue de Verdun, 94010 Créteil, France.
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Yamamoto I, Rogers AH, Reichel E, Yates PA, Duker JS. Intravitreal bevacizumab (Avastin) as treatment for subfoveal choroidal neovascularisation secondary to pathological myopia. Br J Ophthalmol 2006; 91:157-60. [PMID: 16870653 PMCID: PMC1857635 DOI: 10.1136/bjo.2006.096776] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the safety and efficacy of intravitreal bevacizumab (Avastin) as treatment for subfoveal choroidal neovascularisation (CNV) due to pathological myopia. METHODS Consecutive series of primary or recurrent subfoveal CNV secondary to myopia treated with intravitreal bevacizumab 1.25 mg between August 2005 and January 2006 at the New England Eye Center, Boston, Massachusetts, USA, were reviewed retrospectively. Data from clinical examination, fundus photography, fluorescein angiography, optical coherence tomography and visual acuity were collected. RESULTS There were 11 eyes of 9 patients. 5 of 11 eyes had been treated previously with photodynamic therapy. Pre-injection visual acuity measured 20/50 to 20/100 in 6 eyes and 20/200 or worse in 5 eyes. After a mean follow-up of 153 (range 35-224) days, post-injection visual acuity measured 20/20 to 20/40 in 7 eyes, 20/50 to 20/100 in 1 eye and 20/200 or worse in 3 eyes. Three eyes received two bevacizumab injections and eight eyes received one injection. Visual acuity improved by a mean of +3.5 (range -1 to +8 lines) lines, and 8 of 11 eyes achieved 20/50 or better at the last follow-up. Central foveal thickness improved from 340 (range 253-664) microm to 234 (range 142-308) microm, representing an average reduction of 103 (range +4 to -356) microm. No injection complications or drug-related side effects were observed. CONCLUSIONS In this small series of eyes with limited follow-up, intravitreal bevacizumab seems to be safe and potentially efficacious in eyes with subfoveal CNV secondary to pathological myopia.
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Affiliation(s)
- Izumi Yamamoto
- New England Eye Center, Tufts University School of Medicine, Tufts-New England Medical Center, 750 Washington Street, Box 450, Boston, MA 02111, USA
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Murata N, Yamaji T, Uchida M, Tsuboi H, Suzuki H, Yamada M, Oikawa T, Nobuhiro J, Choshi T, Hibino S. Suppression of Laser-Induced Choroidal Neovascularization by Subconjunctival Injection of 9.ALPHA.-Fluoromedroxyprogesterone Acetate (FMPA), an Anti-angiogenic Agent, in Rats. Biol Pharm Bull 2006; 29:2410-4. [PMID: 17142973 DOI: 10.1248/bpb.29.2410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
9alpha-Fluoromedroxyprogesterone acetate (FMPA) is a synthetic analog of medroxyprogesterone acetate (MPA). FMPA exhibited more potent anti-tumor and anti-angiogenic activities in some assay systems than the parent agent, MPA. Exudative age-related macular degeneration (AMD) is characterized by choroidal neovascularization (CNV). Anecortave acetate, an angiostatic steroid, is clinically efficacious in patients with exudative AMD. Betamethasone is an anti-angiogenic steroid. Therefore, we examined the effects of FMPA, anecortave acetate and betamethasone on laser-induced CNV in rats. Anecortave acetate and betamethasone were included as positive controls. Crypton laser was applied to the fundus in Brown Norway rats. Laser photocoagulations were performed in each eye between the major retinal vessels of the superior retina. Subconjunctival injection of FMPA, anecortave acetate or betamethasone was performed once just after the photocoagulation (on day 0). The incidence of CNV formation was evaluated by fluorescein angiography (FAG) on day 14. On the next day, examination of the retinal function was performed by electro retinogram (ERG). Subconjunctival injection of FMPA at doses of 300, 1000 and 3000 microg/eye dose-dependently inhibited the incidence of CNV formation. Significant differences were observed at doses of 1000 and 3000 microg/eye of FMPA as compared with the control group. Anecortave acetate and betamethasone significantly inhibited the incidence of CNV formation. FMPA at the doses used in this study did not affect the retinal function in rats, as determined by ERG. FMPA appeared to be effective in a rat model of CNV, so it was demonstrated that FMPA might be useful in the treatment of AMD.
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Affiliation(s)
- Natsuko Murata
- Pharmaceuticals Development Department, Meiji Dairies Corporation, Tokyo, Japan.
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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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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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Ichibe M, Imai K, Ohta M, Oya Y, Yoshizawa T, Abe H. Simultaneous translocation of the macula and underlying retinal pigment epithelium during macular translocation surgery in a patient with long standing myopic neovascular maculopathy. Br J Ophthalmol 2003; 87:371-2. [PMID: 12598468 PMCID: PMC1771530 DOI: 10.1136/bjo.87.3.371-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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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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