Importance of Paravascular Vitreal Adhesions for Development of Myopic Macular Retinoschisis Detected by Ultra-Widefield OCT.

PURPOSE: To examine most postequatorial retina in eyes with myopic macular retinoschisis (MRS) by ultra-widefield (UWF) OCT and to determine whether paravascular vitreal adhesions play a role in the development of MRS. DESIGN: Retrospective single-center observational case series. PARTICIPANTS: One hundred fifty highly myopic participants who were older than 50 years with and without an MRS were studied. High myopia was defined as an eye with an axial length of more than 26.5 mm. METHODS: All participants underwent UWF OCT imaging with a scan width of 23 mm and a depth of 5 mm using a prototype swept-source OCT device. The vitreoretinal adhesions to the foveal retina and retinal vessels and paravascular abnormalities, including paravascular retinal cysts, paravascular retinoschisis, and paravascular lamellar holes, were analyzed in the UWF OCT images. The findings in eyes with an MRS were compared with those in eyes without an MRS. MAIN OUTCOME MEASURES: The relationships between MRS and vitreal adhesions to the retinal vessels or to the fovea were determined. RESULTS: An MRS was found in 49 of the 150 eyes (33%). Vitreal adhesions to the retinal vessels were found more frequently in eyes with an MRS than in eyes without an MRS (63% vs. 44%; P = 0.04). In contrast, the number of eyes with adhesions to the fovea in eyes with an MRS was not significantly different from that in eyes without an MRS (57% vs. 59%). Paravascular lesions, for example, retinal cysts, retinoschisis, and lamellar holes, were more common in eyes with an MRS than in eyes without an MRS (71% vs. 36%, 61% vs. 17 %, and 20% vs. 8% [P < 0.001, P < 0.001, and P = 0.03], respectively). Multivariate analysis showed that the presence of paravascular vitreal adhesions was a significant predictor for MRS development (odds ratio, 2.56; P = 0.02). CONCLUSIONS: Paravascular vitreal adhesions may be related to the development of the different types of paravascular lesions including retinal cysts and retinoschisis, and play a more important role in the development of an MRS than vitreal adhesions to the fovea.

ASSOCIATION BETWEEN DOME-SHAPED MACULA AND POSTERIOR STAPHYLOMA IN HIGHLY MYOPIC EYES INVESTIGATED BY ULTRA-WIDEFIELD OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To investigate the relationship between dome-shaped maculas (DSMs) and posterior staphylomas in highly myopic eyes. METHODS: Five hundred and eleven eyes of 291 patients with high myopia (refractive error ≤-8.0 diopters or axial length ≥26.5 mm) were examined by ultra-widefield swept-source optical coherence tomography (UWF-OCT). Posterior staphylomas were identified by detecting the staphyloma edges in the UWF-OCT images. RESULTS: Eighty-two eyes of the 511 highly myopic eyes had a DSM, and a posterior staphyloma was observed in 45 of 82 eyes with a DSM (54.9%) and in 301 of 429 eyes (70.2%) without a DSM. The incidence of staphylomas was significantly lower in eyes with a DSM than those without a DSM (P = 0.007). The wide macular type of staphyloma was the predominant type in eyes with a DSM (31/45 eyes; 68.9%), whereas the narrow macular type and wide macular type of staphylomas were present almost equally in the eyes without a DSM. CONCLUSION: The lack of staphylomas in 45% of eyes with a DSM suggests that DSMs form independently from posterior staphylomas. Dome-shaped maculas tend to occur in eyes with a large expansion of the posterior fundus and should be considered a posterior scleral curvature abnormality.

FUNCTIONAL AND STRUCTURAL OUTCOMES AFTER FOVEA-SPARING INTERNAL LIMITING MEMBRANE PEELING FOR MYOPIC MACULAR RETINOSCHISIS BY MICROPERIMETRY.

PURPOSE: To determine the morphological and physiological outcomes and safety of vitrectomy with fovea-sparing internal limiting membrane peeling for myopic macular retinoschisis (MRS). METHODS: Highly myopic eyes (refractive error greater than -8.0 diopters or an axial length longer than 26.5 mm) with MRS that underwent vitrectomy with fovea-sparing internal limiting membrane peeling were analyzed retrospectively. The best-corrected visual acuity, retinal morphology, and the central and paracentral retinal sensitivities at 2°/6° by microperimetry were evaluated before and after the surgery. Postoperative microscotomas were also determined. RESULTS: Thirty-three eyes with MRS; 16 eyes with and 17 eyes without a foveal retinal detachment, were studied. All 33 eyes had an improvement of MRS and foveal retinal detachment partially or completely after surgery, and none developed a full thickness macular hole. The postoperative best-corrected visual acuity, the central retinal sensitivity, and the retinal sensitivity at 2° were significantly better than the preoperative values. Sixteen eyes developed postoperative microscotomas at paracentral 2° and/or 6°. CONCLUSION: The results showed that vitrectomy with fovea-sparing internal limiting membrane peeling is an effective and safe method to treat an MRS regardless of the presence of a foveal retinal detachment. However, careful follow-up should be performed to detect postoperative microscotomas.

DEVELOPMENT OF MACULAR ATROPHY AFTER PARS PLANA VITRECTOMY FOR MYOPIC TRACTION MACULOPATHY AND MACULAR HOLE RETINAL DETACHMENT IN PATHOLOGIC MYOPIA.

PURPOSE: To determine the incidence and long-term outcome of macular atrophy (MA) after pars plana vitrectomy (PPV) in pathologic myopia. METHODS: Highly myopic patients who underwent PPV for myopic traction maculopathy and macular hole retinal detachment at Tokyo Medical and Dental University between 2012 and 2016 were studied. Fundus photographs and/or optical coherence tomography were examined before and after PPV at every visit. RESULTS: A total of 133 eyes were followed for 39 months with the mean age of 62.8 years and the mean axial length of 30.0 mm. Postoperatively, 14 eyes (10.5%) developed fovea-centered MA, observed initially as a small, isolated, whitish lesion at the center of fovea at 3.5 months after PPV. The appearance of the MA was distinctly different from the choroidal neovascularization-related MA or patchy atrophy-related MA. With time, the lesions enlarged circumferentially. In these 14 eyes, the final best-corrected visual acuity was worse than the baseline, although the difference was not significant. The occurrence of MA was significantly associated with the preoperative foveal status. CONCLUSION: The development of MA can occur in 11% of highly myopic eyes after PPV for myopic traction maculopathy and macular hole retinal detachment. This postoperative MA might be a new complication of pathologic myopia.

RIDGE-SHAPED MACULA IN YOUNG MYOPIC PATIENTS AND ITS DIFFERENTIATION FROM TYPICAL DOME-SHAPED MACULA IN ELDERLY MYOPIC PATIENTS.

PURPOSE: To assess and compare clinical features of a ridge-shaped macula (defined as macular elevation only in one meridian across the fovea) in individuals younger than 20 years with those of a dome-shaped macula (DSM) in patients aged 20+ years. METHODS: The retrospective observational case series study included 185 highly myopic eyes of 100 consecutive patients younger than 20 years, who were compared with highly myopic patients with DSMs, aged 20+ years and examined in previous studies. RESULTS: Seventeen (9.2%) eyes of the highly myopic young patients showed macular elevations all of which ran only in the horizontal direction across the vertical optical coherence tomographic section fulfilled the definition of a ridge and did not show any staphylomas or any macular Bruch membrane defects. By contrast, in the older patients with DSMs, the DSMs were significantly higher and had a narrower base than the ridges in the young patients, and showed macular Bruch membrane defects in their vicinity, with the axial length being significantly longer, the myopic maculopathy more severe, and the subfoveal choroid thinner. CONCLUSION: Macular elevations detected in children and adolescents are usually ridge-shaped maculas and do not have the characteristics of DSMs. In comparison with DSMs, ridge-shaped maculas do not show a spatial association with macular Bruch membrane defects or posterior staphylomas and have a wider basis and smoother elevation slope. As a hypothesis, ridge-shaped maculas may be due to a folding of Bruch membrane at the posterior pole, potentially caused by an asymmetrical enlargement of Bruch membrane in the equatorial region.

Rapid and spontaneous resolution of hemorrhagic macular hole retinal detachment and subretinal hemorrhages in an eye with pathologic myopia: a case report.

BACKGROUND: To report a rare case of pathologic myopia in which a choroidal neovascularization (CNV) induced a hemorrhagic macular hole retinal detachment (MHRD), and then both the CNV and MHRD disappeared simultaneously in 5 days. CASE PRESENTATION: A 76-year-old man with pathologic myopia complained of distorted vision in his left eye of 1-week duration. The visual acuity in the left eye was 20/20 and the axial length was 31.0 mm. Ophthalmoscopic examinations of the left eye showed many retinal hemorrhages and whitish lesions on a background of severe diffuse myopic atrophy. Swept-source OCT (SS-OCT) showed multiple hyperreflective vertical finger-like projections extending into the outer retina that corresponded to the area of the botryoidal-shaped retinal hemorrhages. The SS-OCT images also showed many subretinal infiltrations adjacent to linear retinal hemorrhages with a disruption of the adjacent ellipsoid zone of the photoreceptors. Fluorescein angiography (FA) showed early hyperfluorescence and late leakages corresponding to the areas of the hemorrhages or adjacent to the linear retinal hemorrhages. These results suggested that the development of the inflammatory CNV was related to the outer retinopathy or choroiditis as in eyes with punctate inner choroidopathy or multifocal choroiditis rather than myopic CNV. We planned an intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection but the patient noticed a sudden reduction of the visual acuity a few days before the anti-VEGF injection. The left fundus showed a MHRD due to the subretinal hemorrhage. Five days later, the SS-OCT images confirmed a recession of the CNV and a resolution of the MHRD. CONCLUSIONS: Rapid and spontaneous resolution of both myopic CNV and hemorrhagic MHRD suggest that there may have been a mutual mechanism causing the MHRD and CNV. A careful follow-up before doing surgery may be a choice for hemorrhagic MHRD in eyes with pathologic myopia.

OCT-Based Diagnostic Criteria for Different Stages of Myopic Maculopathy.

PURPOSE: To analyze the choroidal thickness (CT) of each type of myopic maculopathy, and to establish an OCT-based classification of myopic maculopathy. DESIGN: Retrospective, hospital-based, cross-sectional study. PARTICIPANTS: Highly myopic (HM) eyes that were examined by swept-source OCT. METHODS: The CT was measured at the subfovea and at 3 mm nasal, temporal, superior, and inferior to the fovea. Myopic maculopathy was classified as tessellation, diffuse atrophy, patchy atrophy, and macular atrophy (MA) based on the fundus photographs. Diffuse atrophy was subdivided into peripapillary diffuse choroidal atrophy (PDCA) or macular diffuse choroidal atrophy (MDCA). MAIN OUTCOME MEASURES: The CT of each type of myopic maculopathy and cut-off value for diagnosis of diffuse atrophy. RESULTS: We studied 1487 eyes of 884 patients (mean age: 58 years; mean axial length [AxL]: 29.9 mm). Subfoveal CT decreased with an increase in the severity of the myopic maculopathy. The mean subfoveal CT in HM eyes with normal fundus was 274.5 µm, with tessellation was 129.1 µm, with PDCA was 84.6 µm, with MDCA was 50.2 µm, with patchy atrophy was 48.6 µm, with choroidal neovascularization-related MA was 27.3 µm, and with patchy atrophy-related MA was 3.5 µm. Using receiver operating characteristic curves, the optimal CT to predict the presence of PDCA was 56.5 µm nasally, and the CT to predict the presence of MDCA was 62 µm subfoveally. The subfoveal CT was not significantly different in eyes with MDCA and patchy atrophy. A decrease of the subfoveal CT was associated with an older age (P < 0.001), longer AxL (P < 0.001), presence of myopic maculopathy (P < 0.001), and presence of CNV (P = 0.002). A decrease of best-corrected visual acuity was not significantly associated with the subfoveal CT. CONCLUSIONS: Progressive and continuous choroidal thinning plays a key role in the progression from no maculopathy to tessellation and to diffuse atrophy. The cut-off value of CT can be used for diagnosing PDCA and MDCA. For progression from MDCA to patchy atrophy, factors other than further choroidal thinning such as Bruch membrane defect may be involved. The subfoveal CT was not a predictor of visual acuity in HM eyes without CNV.

CLINICAL FEATURES OF LACQUER CRACKS IN EYES WITH PATHOLOGIC MYOPIA.

PURPOSE: To analyze the morphologic features of lacquer cracks (LCs), compare their detectability by different imaging instruments, and determine their progressive pattern. METHODS: The medical records of 47 highly myopic eyes of 33 patients with LCs were reviewed. Fundus fluorescein angiography was used as the primary method of identifying LCs, and the detection rate was compared with that by fundus autofluorescence and optical coherence tomography. RESULTS: A total of 176 LCs were detected in the 47 eyes. Lacquer cracks were detected more frequently in the temporal (44.3%) than the inferior (30.7%), superior (17.0%), and nasal (8.0%) quadrants of the retina. The detection rate of LCs was 98% in fundus photographs and 85% by fundus autofluorescence and optical coherence tomography. A progression of the LCs was observed in 22 of the 41 eyes with a follow-up period of ≥1 year. The progression patterns were an increase in the number (18 of 41, including 5 eyes in which new LCs had a branching pattern), elongation (4 of 41), and progression to patchy atrophy (6 of 41). CONCLUSION: Lacquer cracks can be detected noninvasively by fundus autofluorescence and optical coherence tomography; however, improvements are necessary to detect all of the lesions. Lacquer cracks frequently progress with time, and an increase in the number of LCs was the most frequent progression pattern.

POSTERIOR STAPHYLOMAS IN EYES WITH RETINITIS PIGMENTOSA WITHOUT HIGH MYOPIA.

PURPOSE: To describe features of posterior staphylomas in nonhighly myopic eyes with retinitis pigmentosa (RP). METHODS: The retrospective observational case series study included patients with RP and an axial length of <26.5 mm and searched for eyes with posterior staphylomas. All study participants underwent fundus photography and optical coherence tomography. RESULTS: The study identified 13 eyes of 7 patients with a narrow macular staphyloma. Mean age was 40.9 ± 17.9 years (range 9-62 years) and mean axial length was 24.90 ± 0.69 mm. The staphyloma edges corresponded to the margin between the retinal atrophic area in the fundus midperiphery and the relatively unaffected fundus center. On vertically orientated optical coherence tomography images, the staphyloma edges showed a slight inward protrusion of the sclera and a ring-like localized choroidal thinning with choroidal rethickening in direction toward the fovea and toward the periphery of the fundus. The upper and lower staphyloma edges did not differ in steepness. The thickness of the subfoveal choroid (138.6 m ± 50.1 µm) was thinner than the normal range after adjusting for age and axial length in all eyes. Two eyes with advanced RP in the macula showed a subfoveal choroidal thickness of 95 µm and 88 µm. CONCLUSION: Narrow macular staphylomas can occur in nonhighly myopic eyes with RP and, in contrast to staphylomas in highly myopic eyes, show a less marked thinning of the subfoveal choroid. The occurrence of posterior staphylomas in nonhighly myopic eyes with RP may provide hints to unravel the etiology of posterior staphyloma formation.

FIVE-YEAR OUTCOMES OF INTRAVITREAL RANIBIZUMAB FOR CHOROIDAL NEOVASCULARIZATION IN PATIENTS WITH PATHOLOGIC MYOPIA.

PURPOSE: To determine the 5-year outcome of intravitreal ranibizumab (IVR) for myopic choroidal neovascularization (CNV). METHOD: We retrospectively analyzed the medical records of 51 eyes of 51 consecutive patients with myopic CNV who had been treated with IVR with a minimum follow-up period of 5 years after the initial IVR injection. The factors that predicted the best-corrected visual acuity (BCVA) at 5 years after IVR were determined by multiple regression analysis. RESULTS: The mean age of the subjects was 63.6 years, and the mean axial length was 29.4 mm. The mean number of IVR was 1.6, and 34 eyes (66.7%) had only a single IVR. At the baseline and at the 1-year, 2-year, 4-year, and 5-year period, the mean BCVAs were 20/49, 20/37, 20/41, 20/45, and 20/42, respectively. Stepwise multiple regression analysis showed that the BCVA at 5-year period was significantly correlated with the baseline BCVA, the number of IVR injections, and the size of the CNV-related macular atrophy. CONCLUSION: Intravitreal ranibizumab provide a 5-year visual benefit in eyes with myopic CNV compared with the natural course. A lack of enlargement of the CNV-related macular atrophy, a better baseline BCVA, and a minimum number of IVR injections were associated with better visual outcomes.

Ultrawide-Field OCT to Investigate Relationships between Myopic Macular Retinoschisis and Posterior Staphyloma.

PURPOSE: To investigate the relationships between myopic macular retinoschisis (MRS) and posterior staphylomas and to reveal the characteristics of other retinal lesions associated with MRS. DESIGN: Retrospective, observational case series. PARTICIPANTS: Seven hundred twenty-nine eyes of 420 patients with high myopia, which was defined as myopic refractive error of more than -8.0 diopters or an axial length longer than 26.5 mm. METHODS: Highly myopic eyes were examined by ultrawide-field (UWF) swept-source (SS) OCT with scan width of up to 23 mm and scan depth of 5 mm. The OCT features of MRS and posterior staphylomas and their spatial relationship were examined in UWF SS OCT images. MAIN OUTCOME MEASURES: Associations between MRS and staphylomas. RESULTS: In 729 eyes with mean axial length of 30.2±2.1 mm, posterior staphyloma was detected in 482 eyes (66.1%) and MRS was detected in 136 eyes (18.7%). All 136 eyes with an MRS showed outer retinoschisis, and 40 eyes (29.4%) also showed inner retinoschisis. Posterior staphyloma was detected significantly more frequently in eyes with MRS (117/136 [86.0%]) than in eyes without MRS (365/593 [61.6%]; P < 0.001). In all eyes with both staphyloma and outer retinoschisis, the area of the outer retinoschisis was restricted to the area within the staphyloma. In 1 of the 19 eyes with outer retinoschisis but without staphyloma, the outer retinoschisis extended beyond the range of the scanned fundus area. Among the 40 eyes with inner retinoschisis, the inner retinoschisis was located within the region of the outer retinoschisis in 39 eyes (97.5%). In all eyes with inner retinoschisis, retinal lesions causing an inward-directed tractional force were found within the area of the inner retinoschisis. CONCLUSIONS: In highly myopic eyes, the sites of the MRS and staphylomas were spatially related to each other. Posterior-directed force in association with staphylomas, and an inward-directed force resulting from epiretinal membranes or vitreoretinal attachments, may act as causative factors for MRS. However, the exact mechanisms related to the development of an MRS are probably diverse and complex.

Progression of Myopic Maculopathy during 18-Year Follow-up.

PURPOSE: To examine the progression pattern of myopic maculopathy. DESIGN: Retrospective, observational case series. PARTICIPANTS: Highly myopic patients who had been followed up for 10 years or more. METHODS: Using fundus photographs, myopic features were differentiated according to Meta-analysis of Pathologic Myopia (META-PM) Study Group recommendations. MAIN OUTCOME MEASURES: Progression pattern of maculopathy. RESULTS: The study included 810 eyes of 432 patients (mean age, 42.3±16.8 years; mean axial length, 28.8±1.9 mm; mean follow-up, 18.7±7.1 years). The progression rate of myopic maculopathy was 47.0 per 1000 eye-years. Within the pathologic myopia (PM) group (n = 521 eyes), progression of myopic maculopathy was associated with female gender (odds ratio [OR], 2.21; P = 0.001), older age (OR, 1.03; P = 0.002), longer axial length (OR, 1.20; P = 0.007), greater axial elongation (OR, 1.45; P = 0.005), and development of parapapillary atrophy (PPA; OR, 3.14; P < 0.001). Diffuse atrophy, found in 217 eyes without choroidal neovascularization (CNV) or lacquer cracks (LCs) at baseline, progressed in 111 (51%) eyes, leading to macular diffuse atrophy (n = 64; 64/111 or 58%), patchy atrophy (n = 59; 53%), myopic CNV (n = 18; 16%), LCs (n = 9; 5%), and patchy-related macular atrophy (n = 3; 3%). Patchy atrophy, detected in 63 eyes without CNV or LCs at baseline, showed progression in 60 eyes (95%), leading to enlargement of original patchy atrophy (n = 59; 59/60 or 98%), new patchy atrophy (n = 29; 48%), CNV-related macular atrophy (n = 13; 22%), and patchy-related macular atrophy (n = 5; 8%). Of 66 eyes with LCs, 43 eyes (65%) showed progression with development of new patchy atrophy (n = 38; 38/43 or 88%) and new LCs (n = 7; 16%). Reduction in best-corrected visual acuity (BCVA) was associated mainly (all P < 0.001) with the development of CNV or CNV-related macular atrophy and enlargement of macular atrophy. CONCLUSIONS: The most frequent progression patterns were an extension of peripapillary diffuse atrophy to macular diffuse atrophy in diffuse atrophy, enlargement of the original atrophic lesion in patchy atrophy, and development of patchy atrophy in LCs. Main risk factors for progression were older age, longer axial length, and development of PPA.

Suprachoroidal hemorrhage followed by swept-source optical coherence tomography: a case report.

BACKGROUND: To report a case of Suprachoroidal Hemorrhage followed by Swept-Source Optical Coherence Tomography. CASE PRESENTATION: A 66-year-old woman with a rhegmatogenous retinal detachment in her left eye underwent pars plana vitrectomy. During the intraocular photocoagulation for a retinal tear after fluid-air exchange, a vitreous hemorrhage and suprachoroidal hemorrhage (SCH) developed. The surgical incisions were closed after filling the vitreous cavity with silicone oil. Two weeks later, the hemolyzed hemorrhage was removed, and new silicone oil was injected. After the surgery, a low reflective region was detected near the macula in the swept-source optical coherence tomographic (SS-OCT) images. The low reflective region was caused by the residual hemorrhage. The size of the reflective region gradually decreased and was not present at 3 months. We conclude that SS-OCT can be used to follow the resolution of a suprachoroidal hemorrhage. CONCLUSION: SS-OCT can be used to detect and follow the natural course of a suprachoroidal hemorrhage including the absorptive processes.

PERIPAPILLARY ARTERIAL RING OF ZINN-HALLER IN HIGHLY MYOPIC EYES AS DETECTED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

PURPOSE: To visualize the arterial circle of Zinn-Haller (ZHAC) in highly myopic patients by using OCT-A. METHODS: Two hundred and fifty-three eyes of 146 consecutive patients with axial length ≥26.5 mm who underwent OCT-A centered onto the optic disk were studied. RESULTS: Arterial circle of Zinn-Haller was detectable on OCT-A images within the area of the parapapillary myopic conus in 26 (10%) of 253 eyes. The ZHAC was annular in 18 (69%) eyes, triangular in (15%) 4 eyes, and irregular (15%) in 4 eyes. The visibility of the ZHAC on OCT-A images was similar to the visibility on indocyanine green angiograms and significantly better than on conventional fundus photos. Optical coherence tomography angiography visualized details of the ZHAC including the entry of the short posterior ciliary arteries into the circle up to the branches in direction to the optic nerve and ZHAC-associated cilioretinal arteries. In three eyes, the ZHAC was composed of multiple rings. CONCLUSION: Noninvasive OCT-A allowed the visualization of ZHAC up to smaller vessel branches in 10% of highly myopic eyes. Because ZHAC is the main blood supply to lamina cribrosa of optic nerve, OCT-A-based assessment of ZHAC could become of interest in diseases such as glaucomatous optic neuropathy.

SIX-YEAR OUTCOMES OF INTRAVITREAL BEVACIZUMAB FOR CHOROIDAL NEOVASCULARIZATION IN PATIENTS WITH PATHOLOGIC MYOPIA.

PURPOSE: To investigate the 6-year outcome of intravitreal bevacizumab (IVB) to treat eyes with active choroidal neovascularization (CNV) due to pathologic myopia. METHODS: Medical records of 36 eyes of 35 consecutive patients with high myopia (refractive error ≥8 D or axial length ≥26.5 mm) and active CNV, who had been treated with IVB and followed for ≥6 years were analyzed. The factors that predicted the best-corrected visual acuity (BCVA) at 6 years after IVB were determined by multiple regression analyses. RESULTS: The mean age of the subjects was 58 years, and the mean axial length was 29 mm. Twenty-one eyes had subfoveal CNV and 15 eyes had nonsubfoveal CNV. During the 6-year follow-up, the mean number of IVB was 1.78. The mean BCVA logMAR (equivalent Snellen visual acuity) was 0.50 (20/63), 0.31 (20/40), 0.39 (20/50), and 0.45 (20/63) at the baseline, and at 2, 4, and 6 years after the IVB. The BCVA was significantly improved at 2 and 4 years compared with baseline values but not at 6 years. Stepwise multiple regression analyses showed that the BVCA at 6 years was significantly correlated with the size of the CNV-related macular atrophy, and the baseline BCVA and CNV size. CONCLUSION: The significant correlation between the BCVA at 6 years and the size of the macular atrophy indicates that treatments to prevent the development of macular atrophy are important for the long-term visual outcome in eyes with active CNV.

PERIPHERAL PIGMENTED STREAKS IN EYES WITH PATHOLOGIC MYOPIA.

PURPOSE: To determine the incidence and the characteristics of peripheral pigmented streaks in the eyes with pathologic myopia. METHODS: The widefield fundus images of 375 eyes (203 patients) with pathologic myopia were examined. The characteristics of the pigmented streaks existing in the peripheral fundus were analyzed. The spatial relationships between the steep edge of a staphyloma and the distribution of the streaks were also determined. RESULTS: Peripheral streaks were observed in 165 of the 375 eyes (44.0%) as dark, pigmented, radially oriented lesions resembling octopus tentacles. The streaks ran from the mid periphery to the equator. Large choroidal vessels were observed in the corresponding sites, so the streaks probably existed in the layer of the large choroidal vessels or deeper. The patients with streak lesions were significantly older and had a posterior staphyloma more frequently than the eyes without the streaks. The streaks were observed mainly in the area opposite the steep edge of a staphyloma. CONCLUSION: Peripheral pigmented streaks are seen in approximately 44% of eyes with pathologic myopia. The streaks existed in the layer of large choroidal vessels or deeper, and the thinning of the choroid-retina in highly myopic eyes contributes to the visibility of such deep lesions.

Myopic stretch lines: linear lesions in fundus of eyes with pathologic myopia that differ from lacquer cracks.

PURPOSE: To clarify the pathophysiology of linear hypofluorescent lesions observed by fluorescein angiography (FA) in the posterior fundus of eyes with pathologic myopia and to compare the features of these lesions with those of lacquer cracks. METHODS: Medical records of 117 eyes of 81 highly myopic patients, which had linear lesions with abnormal fluorescence by FA were reviewed. Features obtained by fundus autofluorescence, indocyanine green angiography, and optical coherence tomography were also analyzed. RESULTS: In 37 of 117 eyes, the linear lesions were hyperfluorescent in the fluorescein angiograms and appeared yellowish ophthalmoscopically. Optical coherence tomography showed discontinuities of retinal pigment epithelium; thus, they were considered to represent lacquer cracks. In the remaining 80 eyes, the linear lesions were hypofluorescent by FA and ophthalmoscopic observation showed pigmented brown lines. Optical coherence tomography showed clumps of retinal pigment epithelium at the corresponding sites. Although indocyanine green angiography showed hypofluorescence in both types of lesions, fundus autofluorescence showed hyperautofluorescence of hypofluorescent lines by FA and hypoautofluorescence of lacquer cracks. Hypofluorescent lines by FA were considered to be the same as myopic stretch lines. CONCLUSION: There are two types of linear lesions in the posterior fundus of highly myopic eyes; lacquer cracks and myopic stretch lines, and they should be differentiated.

Quantitative Evaluations of Posterior Staphylomas in Highly Myopic Eyes by Ultra-Widefield Optical Coherence Tomography.

Purpose: To determine the shape of posterior staphylomas using ultra-widefield optical coherence tomographic (UWF-OCT) images and to identify the factors contributing to the shape and grade of the staphylomas in eyes with pathologic myopia. Methods: This was an observational case series study. Highly myopic patients who were ≥40 years old with wide or narrow type of macular staphylomas were studied. High myopia was defined as a myopic refractive error (spherical equivalent) greater than -8.0 diopters (D) or an axial length (AL) > 26.5 mm. The maximum diameter and depth of the staphylomas were measured in the 12 radial scans of UWF-OCT images by ImageJ software and were compared between the two types of staphylomas. Results: We studied 197 eyes of 138 patients with a mean age of 64.7 ± 10.4 years and mean AL of 30.0 ± 1.9 mm. The AL was significantly longer in the eyes with the narrow type than the wide type of staphyloma (P = 0.036). Multiple regression analyses showed that age was significantly correlated with the maximum depth/maximum diameter ratio (wide type, P < 0.001; narrow type, P = 0.003) of both types of staphylomas. The AL was significantly correlated with the depth/diameter ratio of only the narrow type of staphylomas (P = 0.005). Conclusions: The significant correlations of age and AL with the wide and narrow types of posterior staphylomas indicate that the factors for their formations may be distinctly different. Quantitative analyses of UWF-OCT images are helpful in determining the shape of the staphylomas.

Posterior vitreous detachment and paravascular retinoschisis in highly myopic young patients detected by ultra-widefield OCT.

The purpose of this study was to determine the relationship between a posterior vitreous detachment (PVD) and retinoschisis (RS) in 73 highly myopic (HM) young patients age 16.4 ± 6.9 years and 24 non-HM children age 8.4 ± 1.5 years. The presence of the paravascular retinal abnormalities was determined in the images obtained by a ultra-widefield OCT (UWF OCT) instrument with an image field of 23 × 20 mm. The results showed that a partial PVD was detected in 15 (21%) of the HM patients, and the number increased significantly with increasing age (P = 0.02). PVDs of any type were not found in the non-HM eyes. The number of microvascular folds also increased with age in the HM patients (P = 0.03). Medium-reflective columnar tissues were present between the detached vitreous and inner retinal surface in 4 (5%) eyes of the HM patients. Myopic RS was found in 3 (4%) HM patients in the paravascular area but not in the macular area. These results suggest that early partial PVD may play a role in pathological and proliferative vitreous changes of HM eyes. An intense vitreoretinal traction with bridging tissues may cause the various paravascular retinal abnormalities. In HM eyes, paravascular RS is already present at an early age which may progress to macular RS with aging.