High myopia has a high genetic tendency, it not only shows in the excessive elongation of the axial length, but also lends to the formation and progression of various eye lesions, such as peripheral retinopathy, optic disc changes, posterior staphyloma, and myopic maculopathy, due to the mechanical stretching of the axial length to the ocular structure. In addition, high myopia increases the risk of several complications, such as glaucoma, cataract, and corneal disease. All these pathological changes will affect visual function and lead to irreversible vision impairment and blindness in the future. Therefore, it is important to pay attention to screening for optic disc abnormalities and posterior staphyloma, and regular monitor the changes of fundus, intraocular pressure, and lens. At the same time, high myopia has an impact on personal life such as study, psychology, sport, and work, and can reduce the quality of life as well as increase the cost of health care. The clinic should pay more attention to high myopia, prevent and control the development of high myopia from an early stage, in order to minimize its impact on ocular structure and visual function as well as its hazard to personal life and society.
ObjectiveTo investigate the clinical characteristics of patients with high-myopia macular hole retinal detachment (MHRD) combined with choroidal detachment and to preliminarily analyze factors associated with postoperative hole closure. MethodsA retrospective clinical case series study. A total of 68 patients with high myopia (68 eyes) with MHRD diagnosed by Department of Ophthalmology, Peking University People’s Hospital from January 2019 to April 2024 were included in this study. Among them, there were 14 males (14 eyes) and 54 females (54 eyes). The mean age was (61.10±9.66) years. All eyes were treated with pars plana vitrectomy (PPV) combined with silicone oil or gas filling. Best corrected visual acuity (BCVA), intraocular pressure, and B-mode ultrasonography were performed. The BCVA test was performed using the Snellen visual acuity chart, which was statistically converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. The range of choroidal detachment was defined according to the number of involved quadrants observed in B-mode ultrasound or surgery, which was divided into 1 to 4 quadrants. Axial length (AL) was measured under retinal reattachment. In 68 eyes, there were 17 eyes with choroidal detachment and 51 eyes without choroidal detachment, respectively. There were 17 eyes with choroidal detachment, and the detachment range involved 1, 2, 2 and 12 eyes in 1, 2, 3 and 4 quadrants, respectively. During operation, 13% C3F8 was filled in 2 eyes, all of which were not complicated with choroidal detachment. 66 eyes were filled with silicone oil. According to whether the patients were complicated with choroidal detachment, the patients were divided into the group without choroidal detachment and the group with choroidal detachment. Independent sample t test, Welch two-sample t test or Mann-Whitney U test were used for comparison between groups. Generalized linear regression and logistic regression were used to analyze the relationship between the aperture size of postoperative unclosed holes and the closed hole after surgery and clinical factors. ResultsAt 3 months after surgery, the logMAR BCVA of the affected eye was 1.29±0.43, with a preoperative to postoperative difference ranging from −1.60 to 0.70 (−0.51±0.51) logMAR units. The AL ranged from 26.6 to 34.3 (29.60±2.12) mm. Among 68 eyes, macular hole of 37 (54.4%, 37/68) eyes were open and 31 (45.6%, 31/68) eyes were closed, respectively. The hole diameter of the open eye was (753±424) µm. There was no significant difference in age, course of disease and AL between the two groups (W=412.0, 477.5, 427.0; P＞0.05). Before operation, BCVA in patients with choroidal detachment was worse (W=257.5) and intraocular pressure was lower (t=4.051) in patients with choroidal detachment compared with those without choroidal detachment, with statistical significance (P＜0.05). At 3 months after surgery, BCVA in patients with choroidal detachment was significantly worse than that in patients without choroidal detachment, with statistical significance (W=284.0, P＜0.05). There were no significant differences in logMAR BCVA difference (t=0.616) and macular hole closure rate (χ2=0.000) before and after surgery (P＞0.05). The reoperation rate of retinal detachment due to persistent or recurrent retinal detachment was significantly higher in the group with choroid detachment than in the group without choroid detachment, and the difference was statistically significant (odds ratio=6.424, P＜0.05). Logistic regression analysis showed that young age was significantly correlated with macular hole closure failure after surgery (β=0.077, P=0.015). There was no correlation between AL, duration of disease, BCVA before surgery, intraocular pressure, wether combined with choroid detachment range and postoperative hole closure (β=−0.072, 0.000, 0.672, −0.085, −0.391; P＞0.05). ConclusionsConcomitant choroidal detachment adversely affected on both pre-operative and post-operative visual acuity in high myopia MHRD. It is closely associated with the risk of recurrent retinal detachment and the needs of multiple operations, but has no significant effect on hole closure rate. Lower age of onset may be a risk factor for macular hole closure.
ObjectiveTo investigate the risk factors of high intraocular pressure (IOP) after femtosecond laser in situ keratomileusis (FS-LASIK) in patients with high myopia, and construct and verify nomogram model. MethodsA retrospective clinical study. From January 2019 to January 2021, 327 patients (654 eyes) with high myopia treated with FS-LASIK in the Department of Ophthalmology of the 910th Hospital of the People's Liberation Army Coalition Security Force were included in the study. The patients were categorized into high IOP group and non-high IOP group according to whether high IOP occurred after surgery, which were 60 cases and 120 eyes (18.35%, 60/327) and 267 cases and 534 eyes (81.65%, 267/327), respectively. The clinical data of patients in the two groups were analyzed and observed, and the indicators with differences were subjected to one-way and multifactorial logistic regression analyses, and the results of the regression analyses were visualized to obtain the column line graphs using R3.5.3 software, and the accuracy of the column line graphs was verified by the consistency index (C-index), the calibration curves, and the subject's work characteristic curves (ROC curves). ResultsComparison of the number of cases of affected corneal thickness (χ2=7.424), corneal curvature (χ2=9.849), glucocorticoid treatment (χ2=7.222), intraoperative IOP fluctuation (χ2=11.475), corneal hysteresis (χ2=6.368), and the incidence of intraoperative complications (χ2=6.673) in the hypertensive IOP group and the nonvisualized IOP group were statistically significant (P＜0.05). Binary logistic regression analysis showed that corneal thickness ＞450 μm, corneal curvature≤38 D, glucocorticoid treatment, intraoperative IOP fluctuation, corneal hysteresis ≤8.0 mm Hg (1 mm Hg=0.133 kPa), and intraoperative complications were the risk factors for the occurrence of high IOP after FS-LASIK surgery in patients with high myopia (P＜0.05). The C-index of the column-line graph prediction model based on this was 0.722 (95% confidence interval 0.684-0.760), the calibration curve and the ideal curve were basically the same, and the area under the ROC curve was 0.709. ConclusionsCorneal thickness＞450 μm, keratometric curvature ≤38 D, glucocorticoid treatment, intraoperative fluctuation of intraocular pressure, and corneal hysteresis ≤8.0 mm Hg are the risk factors for the development of hyperopic IOP in highly risk factors for the development of high IOP after FS-LASIK surgery in myopic patients. The column-line diagram model constructed on the basis of the risk factors hava good accuracy.
ObjectiveTo compare the efficacy of pars plana vitrectomy (PPV) combined inverted internal limiting membrane (ILM) with PPV combined ILM peeling for macular hole retinal detachment (MHRD) in high myopia.MethodsA retrospective clinical study. From October 2012 to January 2019, 78 patients (78 eyes) with high myopia macular hole retinal detachment diagnosed from Chongqing Aier Eye Hospital and Hefei Aier Eye Hospital were included in the study. Among them, there were 11 males (11 eyes) and 67 females (67 eyes) with the average age of 55.6±9.6 years. All patients underwent BCVA, diopter, OCT examination and axial length (AL) measurement. The standard logarithmic visual acuity chart was used for BCVA examination, and the visual acuity was converted to logMAR when recorded. Patients were divided into PPV combined with ILM peeling group (ILM peeling group) and PPV combined with ILM inverted group (ILM inverted group) according to the surgical method, with 51 patients (51 eyes) and 27 patients (27 eyes), respectively. The average age (t=－1.170), diopter (t=0.504), AL (t=0.474), logMAR BCVA (t=0.935), and hole diameter (t=－0.334) of the two groups were compared, and there was no statistically significant difference (P＞0.05). Two independent sample t test was used to compare the exposed distance of BCVA and RPE before and after the operation of the two groups of eyes. The χ2 test was used to compare the rates between the two groups.ResultsAt the last follow-up, the logMAR BCVA of the eyes in the ILM inverted group and ILM peeling group were 0.87±0.27 and 1.45±0.39, respectively. Compared with pre-operation, the BCVA of the two groups of eyes were significantly improved, and the difference was statistically significant (t=8.790, 4.640, P＜0.001,＜0.001). The logMAR BCVA of the two groups of eyes was compared with statistical significance (t=6.830, P＜0.001). The exposed RPE distances of the eyes in the ILM inverted group and the inner limiting membrane peeling group were 31.81±23.52 and 681.80±466.61 μm, respectively. the difference in the RPE exposure distance between the two groups was statistically significant (t=7.180, P＜0.001). The holes in the 27 eyes in the ILM inverted group were healed (100%, 27/27); no retinal detachment occurred. Among the 51 eyes in the ILM peeling group, the hole healed in 45 eyes (88.2%, 45/51), and the retina was detached in 6 eyes (11.8%, 6/51). There was a statistically significant difference in the incidence of retinal detachment between the two groups of patients (χ2=45.440, P=0.000).ConclusionCompared to ILM peeling, inverted ILM has provided better RPE protection and reduce the rate of retinal redetachment in patients with MHRD.
ObjectiveTo observe and analyze the superficial retinal blood flow density and its related influencing factors in the macular area of adolescents with different types of non-pathological high myopia (HM). MethodsA retrospective clinical study. From March to August 2022, 117 eyes of 117 adolescents who were admitted to Liaocheng Aier Eye Hospital due to myopia were included in the study. According to equivalent spherical degree (SE) and corneal curvature, subjects were divided into mild myopia or emmetropia group (control group), HM group, occult HM (OHM) group, and super HM (SHM) group, with 30 eyes, 28 eyes, 35 eyes, and 24 eyes, respectively. All subjects underwent medical optometry, intraocular pressure, optical coherence tomography (OCT), OCT angiography (OCTA), axial length (AL) and corneal curvature measurements. The diopter was SE. OCTA instrument was used to scan the macular region in the range of 6 mm×6 mm, and the software automatically divided it into three concentric circles centered on the fovea of the macular, namely, the central area with a diameter of 1 mm, the inner ring area with a diameter of 1-3 mm, and the outer ring area with a diameter of 3-6 mm. The superficial retinal vascular density (SRVD), vascular perfusion density (SBPD), the area, perimeter (PERIM), avascular index (AI) of foveal avascular area (FAZ) and retinal thickness were measured in the macular region as a whole and in different regions. One-way analysis of variance was used to compare the data among groups, and the least significant difference t-test was used to compare the data among groups. The correlation of AL, corneal curvature and intraocular pressure with SRVD and SBPD in macula was analyzed by Pearson correlation analysis. ResultsThere were significant differences in SRVD and SBPD in the central, inner and outer regions of macula in control group, HM group, OHM group and SHM group (P＜0.05). There were statistically significant differences in the thickness of the retina above, below and on the temporal side of the central and outer ring regions (P＜0.05). However, no statistically significant difference was in the thickness of the retina on the nasal side (P＞0.05). There was no significant difference in PERIM (P＞0.05). There were significant differences in FAZ area and AI (P＜0.05). Correlation analysis showed that AL was negatively correlated with SRVD and SBPD in macular whole and central, inner and outer ring regions (P＜0.05). Corneal curvature and SE were positively correlated with the SRVD and SBPD of macular whole, central area and outer ring area (P＜0.05). AL was negatively correlated with retinal thickness in the outer ring region (P＜0.05). SE was positively correlated with the thickness of the retina above, below and temporally in the outer ring region (P＜0.05). AL was negatively correlated with FAZ area and AI (P＜0.05). SE was positively correlated with FAZ area and PERIM (P＜0.05). Retinal thickness was positively correlated with SRVD and SBPD (P＜0.05). ConclusionsThe SRVD and SBPD of different types of HM in adolescents decreases to different degrees. The thickness of the retina in the central region is thicker, and the retina in the outer ring region is thinner. With the decrease of SRVD, the retinal thickness gradually is thinner.
Objective To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and C3F8 tamponade for patients with highly myopic macular hole (HM-MH) with and without foveoschisis. MethodsA retrospective case controlled study. From January 2017 to February 2022, 23 eyes of 23 patients with highly myopic macular hole with and without foveoschisis diagnosed in the Shandong Eye Hospital were included in the study. Among them, 5 males had 5 eyes, and 18 females had 18 eyes, the age was (54.43±12.96) years old. The patients with or without foveoschisis were 12 eyes in 12 cases and 11 eyes in 11 cases. Studies were divided into two groups, depending on the presence of a concomitant myopic foveoschisis or not. The groups are high myopia macular hole with foveoschisis (group A) and high myopia macular hole without foveoschisis (group B). Best-corrected visual acuity (BCVA), B-scan ultrasonography, optical coherence tomography and axial length (AL) measurement were performed in all eyes. Snellen chart was used for BCVA examination, and the visual acuity was converted into logarithm of minimum angle of resolution (logMAR) during statistics. The age of the two groups, sex, macular hole (MH) diameter, logMAR BCVA, AL, posterior scleral staphyloma, there was no significant difference (P＞0.05). PPV combined with ILM peeling and C3F8 filling were performed in all eyes. Follow-up was at least 3 months after the last operation. BCVA changes and MH closure were compared between the two groups after surgery. Wilcoxon test was used to compare BCVA before and after operation. Mann-whiteny U test was used to compare preoperative and postoperative BCVA between groups. ResultsAfter initial surgery, MH was closed in 17 of 23 eyes (74%, 17/23). MH was closed in 8 eyes in group A (66.7%, 8/12). Four eyes were not closed (33.3%, 4/12); MH closed in 9 eyes in group B (81.8%, 9/11). There was no significant difference between the two groups after initial operation (P＞0.05). At 1 and 3 months after surgery, the logMAR BCVA of patients in group A and group B were 1.00±0.46, 1.03±0.83 and 0.53±0.63, 0.55±0.41, respectively. Compared with before operation, there was no significant difference at 1 month (P=0.783, 0.358), but the difference was statistically significant at 3 months (P=0.012, 0.007). There was no significant difference in logMAR BCVA between group A and group B at 1 and 3 months after operation (P=0.687, 0.950). ConclusionPPV combined with ILM peeling and C3F8 tamponade can promote MH closure and improve visual acuity in most affected eyes with HM-MH with and without foveoschisis.
ObjectiveTo observe the imaging features of extramacular retinoschisis (EMRS) and paravascular abnormalities (PVA) in myopic patients, and preliminary analyze the differences in age, best corrected visual acuity (BCVA), spherical equivalent (SE), axial length (AL), and subfoveal choroidal thickness (SFCT). MethodsA cross-sectional clinical study. A total of 60 myopia patients with EMRS who were admitted to Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University from January 2023 to June 2024 were included in the study. There were 18 male cases with 18 eyes and 42 female cases with 42 eyes. Age was (37.57±17.14) years; SE was (−10.76±4.66) D; AL was (28.36±1.87) mm. According to the characteristics of ultra-wide-angle optical coherence tomography images, PVA was divided into perivascular cysts (PC), perivascular microfolds (PM) and perivascular lamellar holes (PLH). According to the splitting level, EMRS can be divided into inner layer, middle layer and outer layer. According to SE, the affected eyes were divided into low myopia group, moderate myopia group and high myopia group. The occurrence of EMRS near optic disc, supratemporal, suprasal and subnasal, as well as the clinical characteristics of patients with EMRS at different locations, levels and forms of PVA were observed. Age, BCVA, SE, AL and SFCT of EMRS patients at different locations and levels were compared by independent sample t test. χ2 test or Fisher exact probability test were used to compare the categorical variables between groups. ResultsIn 60 eyes, EMRS were located in supratemporal, infratemporal, supranasal, subnasal, and paratopic discs in 36, 43, 15, 13, and 14 eyes, respectively. The EMRS in the inner and outer layers were 59 (98.3%, 59/60) and 35 (58.3%, 35/60) eyes, respectively. PVA was present in 47 eyes (78.3%, 47/60). Among them, PC, PM and PLH were 45, 39 and 18 eyes, respectively. The age of those with paratopic splitting was older than those without paratopic splitting (t=2.720). Those with temporal splitting had worse BCVA and longer AL than those without splitting (t=2.139, 2.119). Those with subnasal splitting had worse BCVA, higher myopia, longer AL and thinner SFCT than those without splitting. The differences were statistically significant (t=2.926, −2.640, 2.635, −3.938; P＜0.05). Compared with other types of EMRS, patients with inner EMRS had younger age (t=−2.383), better BCVA (t=−4.825), shorter AL (t=−4.767), lower myopia (t=4.791), and thicker SFCT (t=4.791); patients with full-layer EMRS were older (t=2.419), worse BCVA (t=3.656), longer AL (t=2.677), higher degree of myopia (t=−2.755), and thinner SFCT (t=−3.283), with statistical significance (P＜0.05). There was significant difference in SFCT among patients with or without PC (t=−2.396, P＜0.05). Compared with eyes without PM and PLH, eyes with PM had worse BCVA, longer AL, higher myopia, and thinner SFCT, and the differences were statistically significant (PM: t=2.514, 3.078, −2.811, −4.205; P＜0.05; PLH: t=2.514, 2.992, −2.949, −1.773; P＜0.05). ConclusionsEMRS primarily occurs in the temporal side, with the highest frequency in the inner layer. Patients with inner-layer EMRS are younger, have better BCVA, shorter AL, lower myopia, and thicker SFCT, whereas patients with full-layer EMRS exhibit the opposite characteristics.