Myopic CNV

Choroidal neovascularisation secondary to pathological myopia is the most common cause of severe visual impairment in myopic patients younger than 50 years old. The typical features of myopic CNV in contrast to age-related macular degeneration as well as the anatomic characteristics have an impact on the parameters of the baseline and follow-up examinations. As the usually small fibrovascular lesions show a rapid progression in the spontaneous course of the disease and lead to irreversible damage to the photoreceptors, prompt initiation of treatment is mandatory. The superior functional results of anti-VEGF drugs provide the reason for the first-line status of this treatment modality. Increasing safety data and consistent results of prospective pilot trials have proved photodynamic therapy to be inferior. There are signs that PRN-based treatment algorithms may allow for less frequent dosing than in other retinal diseases.     

Myopic astigmatism and presbyopia trial

PURPOSE: No prospective double-masked study has evaluated whether low astigmatism benefits or harms patients with presbyopia, whose intermediate and near vision might theoretically benefit from enhanced depth of focus provided by astigmatism. The purpose of the first Myopic Astigmatism and Presbyopia (MAP I) study was to determine whether low myopic astigmatism enhances or harms the visual acuity, stereopsis, or quality of life in patients with presbyopia. DESIGN: Prospective, randomized, double-masked, crossover design clinical trial. METHODS: Fifteen patients with presbyopia aged 45 to 68 years were recruited from an academic center population. These patients were given a baseline eye examination, including manifest refraction, Early Treatment of Diabetic Retinopathy Study (ETDRS) logarithm of minimal angle of resolution (logMAR) visual acuity at distance, intermediate, and near, accommodative amplitudes, and stereo vision. Each patient was then cycled in random order through three masked pairs of soft contact lenses. The power of each contact lens pair was calculated by the subtraction method to maintain a spherical equivalent of -0.5 diopters, while providing either no astigmatism (spherical arm, SPH), 1 diopter of with-the-rule (WTR) astigmatism, or 1 diopter of against-the-rule (ATR) astigmatism. Actual refractive errors produced were measured by masked examiner. Outcomes measured at the end of 1 week of usage of each contact lens arm were binocular (ETDRS) logMAR visual acuity at three distances (far [4 m], intermediate [1 m], and near [33cm]); near stereoacuity, using the quantitative Titmus Stereotest; and quality of life, measured using the Refractive Status and Vision Profile (RSVP), a standardized questionnaire. RESULTS: Visual acuity results across the three arms were similar. However, 1-m logMAR visual acuity was better for the spherical arm than either astigmatic arm (-0.06 SPH, +0.01 WTR, +0.02 ATR). Near (33 cm) and distance (4 m) acuities were similar across arms. Stereoacuity was better in ATR than WTR (50 vs 102 seconds, P =.01). Subjects preferred SPH slightly over the WTR astigmatic arm by the RSVP quality-of-life survey instrument (101 vs 104, P =.05). Other intergroup comparisons showed no difference in RSVP scores. CONCLUSIONS: This study has demonstrated that intermediate distance acuity and refractive quality of life are slightly better with spherical low myopic refractive error vs either astigmatic arm. Near and far distance acuity were unaffected by low myopic astigmatism compared with spherical low myopia. Near stereopsis was best in the ATR arms, but this did not produce better near visual acuity or RSVP quality of life.     

高度近视患者黄斑病变分型与视网膜劈裂的关系

目的：观察高度近视患者黄斑病变国际分型特征及其与视网膜劈裂之间的关系。方法：回顾性系列病例研究。收集2015年10月至2017年12月于上海交通大学附属第一人民医院眼科门诊就诊的116例（174眼）高度近视患者的病史资料和眼科检查信息，所有患者均接受眼底照相及高清OCT扫描检查，对图像进行分析评价。计量资料采用独立样本t检验或单因素方差分析。计数资料的比较采用Fisher's精确概率法。结果：116例（174眼）高度近视患者根据眼底彩照图像特征可分为5型：C0无近视退行性病变型（10眼）、C1豹纹状眼底病变型（74眼）、C2弥漫视网膜脉络膜萎缩型（36眼）、C3片状视网膜脉络膜萎缩型（25眼）、C4黄斑萎缩型（29眼）。其中70眼（40%）合并视网膜劈裂，均发生在C1、C2、C3、C4型中，其中C2型的发生率（58%）最高。结论：基于眼底彩照的国际分型结合OCT显示弥漫视网膜脉络膜萎缩型高度近视黄斑病变发生视网膜劈裂的可能性大。     

Myopic strabismus fixus convergens

A case report of myopic myositis, a rare entity, leading to strabismus fixus convergens, occurring in a high myope at the age of 46 years is presented. The possible differential diagnosis along with the aetiopathogenesis is discussed.     

Myopic peripheral retinal degenerations

The article shows periferical retinal degenerations which appear in myopia. The places, the ophthalmoscopical aspect and histopathological aspect of each retinal change and the complications that may appear are presented. In the end some principles of treatment are presented.     

准分子激光角膜切削术后的屈光回退

目的通过准分子激光角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ,ＰＲＫ）术后屈光回退的分析,以期探讨可能影响回退的因素。方法经ＰＲＫ手术治疗近视于术后发生回退（≥－１．００Ｄ）１０３只眼,术前屈光度－４．００～－１４．５０Ｄ（－８．７５±２．６５Ｄ）。分为二组进行比较,Ⅰ组为中度近视（－４．００～－７．９０Ｄ）,Ⅱ组为高度近视（≥－８．００Ｄ）。结果中度近视回退率１．１７％,高度近视回退率６．９３％（Ｐ＜０．００１）。高年龄组回退率较低年龄组高（Ｐ＜０．０１）。较严重的角膜上皮下雾状混浊（ｈａｚｅ）多与回退伴行。因激素性高眼压减少或停止局部糖皮质激素的应用可导致回退,屈光的稳定性与性别无关,回退常伴Ｋ值增大。结论回退与预期矫正度、年龄以及ｈａｚｅ有明显相关     

Myopic foveoschisis: a clinical review

To review the literature on epidemiology, clinical features, diagnostic imaging, natural history, management, therapeutic approaches, and prognosis of myopic foveoschisis. A systematic Pubmed search was conducted using search terms: myopia, myopic, staphyloma, foveoschisis, and myopic foveoschisis. The evidence base for each section was organised and reviewed. Where possible an authors'' interpretation or conclusion is provided for each section. The term myopic foveoschisis was first coined in 1999. It is associated with posterior staphyloma in high myopia, and is often asymptomatic initially but progresses slowly, leading to loss of central vision from foveal detachment or macular hole formation. Optical coherence tomography is used to diagnose the splitting of the neural retina into a thicker inner layer and a thinner outer layer, but compound variants of the splits have been identified. Vitrectomy with an internal limiting membrane peel and gas tamponade is the preferred approach for eyes with vision decline. There has been a surge of new information on myopic foveoschisis. Advances in optical coherence tomography will continually improve our understanding of the pathogenesis of retinal splitting, and the mechanisms that lead to macular damage and visual loss. Currently, there is a good level of consensus that surgical intervention should be considered when there is progressive visual decline from myopic foveoschisis.     

Myopic anisometropia: ocular characteristics and aetiological considerations

Anisometropia represents a unique example of ocular development, where the two eyes of an individual, with an identical genetic background and seemingly subject to identical environmental influences, can grow asymmetrically to produce significantly different refractive errors. This review provides an overview of the research examining myopic anisometropia, the ocular characteristics underlying the condition and the potential aetiological factors involved. Various mechanical factors are discussed, including corneal structure, intraocular pressure and forces generated during near work that may contribute to development of anisomyopia. Potential visually guided mechanisms of unequal ocular growth are also explored, including the influence of astigmatism, accommodation, higher‐order aberrations and the choroidal response to altered visual experience. The association between binocular vision, ocular dominance and asymmetric refraction is also considered, along with a review of the genetic contribution to the aetiology of myopic anisometropia. Despite a significant amount of research into the biomechanical, structural and optical characteristics of anisometropic eyes, there is still no unifying theory, which adequately explains how two eyes within the same visual system grow to different endpoints.     

Myopic choroidal neovascularization: natural course and treatment

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.