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1.
PLoS One ; 15(5): e0232852, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32374792

RESUMO

PURPOSE: To evaluate the clinical characteristics and evolution of lamellar macular hole (LMH) in high myopia and the parameters associated with structural worsening, defined as the development of foveal detachment or full-thickness macular hole. METHODS: Patients with high myopia and LMH were retrospectively recruited. The clinical characteristics and various parameters of optical coherence tomography were identified at baseline and during follow-up visits. Cox regression analysis was used to evaluate the hazard ratios for foveal detachment and full-thickness macular hole. RESULTS: Among 112 eyes (98 patients), 64.3% were female; the mean axial length of all eyes was 29.6 ± 1.9 mm. The 'LMH without retinoschisis' group accounted for 39.3% of the eyes. Forty-two percent developed structural worsening within a median follow-up of 67 months. Multivariable regression on all cases showed elevated tissue inside the LMH (P = 0.003) protected against structural worsening while V-shaped LMH (P = 0.006) predicted it. In the "LMH with retinoschisis group", ellipsoid zone disruption (P = 0.035), and V-shaped LMH (P = 0.014) predicted structural worsening, while elevated tissue inside the LMH (P = 0.028) protected against it. In the "LMH without retinoschisis group", no associated factor was identified. CONCLUSIONS: LMHs in high myopia are unstable, especially those with V-shaped LMH. Elevated tissue inside LMHs have a protective effect against further structural worsening.


Assuntos
Miopia Degenerativa/complicações , Perfurações Retinianas/etiologia , Idoso , Progressão da Doença , Membrana Epirretiniana/etiologia , Feminino , Seguimentos , Fóvea Central/ultraestrutura , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Descolamento Retiniano/etiologia , Perfurações Retinianas/fisiopatologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual
2.
Am J Ophthalmol ; 214: 110-118, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32171766

RESUMO

PURPOSE: To evaluate the performance of Holladay 1 and SRK/T formulas with the axial length (AL) adjustment methods including the linear and nonlinear versions of Wang-Koch AL adjustment methods and Cooke-modified AL (CMAL); and to determine whether the CMAL should be extended to the latest Barrett Universal II, Ladas Super formula (LSF), and Emmetropia Verifying Optical formulas in highly myopic eyes. DESIGN: Retrospective, consecutive case-series study. METHODS: A total of 164 eyes of 164 patients with AL ≥26.0 mm were included and divided into 2 groups: AL <28.0 mm (Group 1) and AL ≥28.0 mm (Group 2). The average arithmetic spherical equivalent prediction error (PE), mean absolute PE, median absolute error (MedAE), and the percentage of eyes within ±0.25 diopter (D), ±0.50 D, and ±1.0 D of PE were determined. RESULTS: The Holladay 1 formulas showed the smallest MedAE when combined with the first linear or nonlinear version of Wang-Koch AL adjustment methods, both in total and in subgroups. The SRK/T formula displayed the highest prediction accuracy in combination with the first linear version of Wang-Koch adjustment method in total and subgroups. The CMAL reduced the absolute PE of LSF in total (P = .003) and in Group 1 (P = .017). CONCLUSIONS: The Holladay 1 and SRK/T formulas combined with specific AL adjustment methods had accuracy similar to the fourth-generation formulas for highly myopic eyes. Moreover, the CMAL can improve the accuracy of the LSF for highly myopic eyes.


Assuntos
Comprimento Axial do Olho/patologia , Biometria/métodos , Implante de Lente Intraocular , Lentes Intraoculares , Miopia Degenerativa/patologia , Facoemulsificação , Idoso , Catarata/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Óptica e Fotônica , Estudos Retrospectivos , Acuidade Visual
3.
Cochrane Database Syst Rev ; 1: CD004916, 2020 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-31930781

RESUMO

BACKGROUND: Nearsightedness (myopia) causes blurry vision when one is looking at distant objects. Interventions to slow the progression of myopia in children include multifocal spectacles, contact lenses, and pharmaceutical agents. OBJECTIVES: To assess the effects of interventions, including spectacles, contact lenses, and pharmaceutical agents in slowing myopia progression in children. SEARCH METHODS: We searched CENTRAL; Ovid MEDLINE; Embase.com; PubMed; the LILACS Database; and two trial registrations up to February 2018. A top up search was done in February 2019. SELECTION CRITERIA: We included randomized controlled trials (RCTs). We excluded studies when most participants were older than 18 years at baseline. We also excluded studies when participants had less than -0.25 diopters (D) spherical equivalent myopia. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods. MAIN RESULTS: We included 41 studies (6772 participants). Twenty-one studies contributed data to at least one meta-analysis. Interventions included spectacles, contact lenses, pharmaceutical agents, and combination treatments. Most studies were conducted in Asia or in the United States. Except one, all studies included children 18 years or younger. Many studies were at high risk of performance and attrition bias. Spectacle lenses: undercorrection of myopia increased myopia progression slightly in two studies; children whose vision was undercorrected progressed on average -0.15 D (95% confidence interval [CI] -0.29 to 0.00; n = 142; low-certainty evidence) more than those wearing fully corrected single vision lenses (SVLs). In one study, axial length increased 0.05 mm (95% CI -0.01 to 0.11) more in the undercorrected group than in the fully corrected group (n = 94; low-certainty evidence). Multifocal lenses (bifocal spectacles or progressive addition lenses) yielded small effect in slowing myopia progression; children wearing multifocal lenses progressed on average 0.14 D (95% CI 0.08 to 0.21; n = 1463; moderate-certainty evidence) less than children wearing SVLs. In four studies, axial elongation was less for multifocal lens wearers than for SVL wearers (-0.06 mm, 95% CI -0.09 to -0.04; n = 896; moderate-certainty evidence). Three studies evaluating different peripheral plus spectacle lenses versus SVLs reported inconsistent results for refractive error and axial length outcomes (n = 597; low-certainty evidence). Contact lenses: there may be little or no difference between vision of children wearing bifocal soft contact lenses (SCLs) and children wearing single vision SCLs (mean difference (MD) 0.20D, 95% CI -0.06 to 0.47; n = 300; low-certainty evidence). Axial elongation was less for bifocal SCL wearers than for single vision SCL wearers (MD -0.11 mm, 95% CI -0.14 to -0.08; n = 300; low-certainty evidence). Two studies investigating rigid gas permeable contact lenses (RGPCLs) showed inconsistent results in myopia progression; these two studies also found no evidence of difference in axial elongation (MD 0.02mm, 95% CI -0.05 to 0.10; n = 415; very low-certainty evidence). Orthokeratology contact lenses were more effective than SVLs in slowing axial elongation (MD -0.28 mm, 95% CI -0.38 to -0.19; n = 106; moderate-certainty evidence). Two studies comparing spherical aberration SCLs with single vision SCLs reported no difference in myopia progression nor in axial length (n = 209; low-certainty evidence). Pharmaceutical agents: at one year, children receiving atropine eye drops (3 studies; n = 629), pirenzepine gel (2 studies; n = 326), or cyclopentolate eye drops (1 study; n = 64) showed significantly less myopic progression compared with children receiving placebo: MD 1.00 D (95% CI 0.93 to 1.07), 0.31 D (95% CI 0.17 to 0.44), and 0.34 (95% CI 0.08 to 0.60), respectively (moderate-certainty evidence). Axial elongation was less for children treated with atropine (MD -0.35 mm, 95% CI -0.38 to -0.31; n = 502) and pirenzepine (MD -0.13 mm, 95% CI -0.14 to -0.12; n = 326) than for those treated with placebo (moderate-certainty evidence) in two studies. Another study showed favorable results for three different doses of atropine eye drops compared with tropicamide eye drops (MD 0.78 D, 95% CI 0.49 to 1.07 for 0.1% atropine; MD 0.81 D, 95% CI 0.57 to 1.05 for 0.25% atropine; and MD 1.01 D, 95% CI 0.74 to 1.28 for 0.5% atropine; n = 196; low-certainty evidence) but did not report axial length. Systemic 7-methylxanthine had little to no effect on myopic progression (MD 0.07 D, 95% CI -0.09 to 0.24) nor on axial elongation (MD -0.03 mm, 95% CI -0.10 to 0.03) compared with placebo in one study (n = 77; moderate-certainty evidence). One study did not find slowed myopia progression when comparing timolol eye drops with no drops (MD -0.05 D, 95% CI -0.21 to 0.11; n = 95; low-certainty evidence). Combinations of interventions: two studies found that children treated with atropine plus multifocal spectacles progressed 0.78 D (95% CI 0.54 to 1.02) less than children treated with placebo plus SVLs (n = 191; moderate-certainty evidence). One study reported -0.37 mm (95% CI -0.47 to -0.27) axial elongation for atropine and multifocal spectacles when compared with placebo plus SVLs (n = 127; moderate-certainty evidence). Compared with children treated with cyclopentolate plus SVLs, those treated with atropine plus multifocal spectacles progressed 0.36 D less (95% CI 0.11 to 0.61; n = 64; moderate-certainty evidence). Bifocal spectacles showed small or negligible effect compared with SVLs plus timolol drops in one study (MD 0.19 D, 95% CI 0.06 to 0.32; n = 97; moderate-certainty evidence). One study comparing tropicamide plus bifocal spectacles versus SVLs reported no statistically significant differences between groups without quantitative results. No serious adverse events were reported across all interventions. Participants receiving antimuscarinic topical medications were more likely to experience accommodation difficulties (Risk Ratio [RR] 9.05, 95% CI 4.09 to 20.01) and papillae and follicles (RR 3.22, 95% CI 2.11 to 4.90) than participants receiving placebo (n=387; moderate-certainty evidence). AUTHORS' CONCLUSIONS: Antimuscarinic topical medication is effective in slowing myopia progression in children. Multifocal lenses, either spectacles or contact lenses, may also confer a small benefit. Orthokeratology contact lenses, although not intended to modify refractive error, were more effective than SVLs in slowing axial elongation. We found only low or very low-certainty evidence to support RGPCLs and sperical aberration SCLs.


Assuntos
Miopia Degenerativa/terapia , Soluções Oftálmicas/uso terapêutico , Atropina/uso terapêutico , Criança , Lentes de Contato , Ciclopentolato/uso terapêutico , Humanos , Antagonistas Muscarínicos/uso terapêutico , Pirenzepina/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Ocul Immunol Inflamm ; 28(3): 396-401, 2020 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30994377

RESUMO

Purpose: To investigate the relation between high axial myopia and neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) values.Methods: Seventy-nine cases were enrolled, 50 myopic and 29 emmetropic. All participants were assigned into three groups: Group I (high myopia with no retinal involvement), Group II (high myopia with retinal involvement) and Group III (control). NLR and PLR values calculated from blood tests were compared among the groups.Results: Mean NLR levels were 2.23 ± 0.78 in Group I, 2.36 ± 1.06 in Group II, and 1.57 ± 0.33 in Group III. Mean PLR levels were 114.62 ± 23.21 in Group I, 145.16 ± 52.36 in Group II, and 91.42 ± 18.73 in Group III. NLR and PLR values in the high myopia groups were significantly higher than in the control group.Conclusion: NLR and PLR values in cases with high axial myopia were higher than in the emmetropic group. Higher inflammation in the degenerative myopic group in particular may be related to pathological chorioretinal changes.


Assuntos
Plaquetas/patologia , Linfócitos/patologia , Miopia Degenerativa/sangue , Neutrófilos/patologia , Refração Ocular/fisiologia , Adolescente , Adulto , Idoso , Progressão da Doença , Feminino , Seguimentos , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Miopia Degenerativa/fisiopatologia , Contagem de Plaquetas , Estudos Prospectivos , Adulto Jovem
5.
Am J Ophthalmol ; 211: 42-55, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31678559

RESUMO

PURPOSE: To evaluate the safety and efficacy of femtosecond (fs) laser-assisted in situ keratomileusis (LASIK) combined with accelerated corneal cross-linking (LASIK Xtra) compared to conventional fs-LASIK (convLASIK) in high myopic patients. DESIGN: Prospective, randomized, fellow-eye controlled clinical trial. METHODS: Setting: Department of Ophthalmology, Goethe University, Frankfurt/Germany. StudyPopulation: Twenty-six patients with high myopia and/or myopic astigmatism received randomized treatment with LASIK Xtra (30 mW/cm2, 90 seconds with continuous ultraviolet-A) in 1 eye and convLASIK in the other eye. MainOutcomeMeasures: Uncorrected distance visual acuity (UDVA), best spectacle-corrected VA (BSCVA), manifest refractive spherical equivalent (MRSE), endothelial cell count (ECC), and corneal thickness. RESULTS: The UDVA improved from 1.26 ± 0.13 logMAR preoperative to -0.02 ± 0.15logMAR in LASIK Xtra eyes and from 1.27 ± 0.12 logMAR to 0.01 ± 0.15 logMAR in the convLASIK eyes (P > .05). The MRSE changed from -7.35 ± 1.15 diopters (D) and -7.5 ± 1.12 D to -0.17 ± 0.43 D and -0.25 ± 0.46 D, respectively. There was no significant difference in outcomes between both groups during the 12 months follow-up except for the convLASIK eyes' showing slightly better BSCVA after 1 week (P < .05). ConvLASIK eyes revealed a nonsignificant trend toward myopic regression from 3 to 12 months postoperative with a change in MRSE of -0.15 D compared to -0.1 D in LASIK Xtra eyes. Topography showed stability of corneal curvature with no signs of keratectasia in both groups at 12 months. CONCLUSION: While apparently safe, LASIK Xtra showed no advantages over conventional LASIK. At 12 months, both groups showed no difference regarding UDVA and refractive stability, and no signs of keratectasia.


Assuntos
Reagentes para Ligações Cruzadas , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Lasers de Excimer/uso terapêutico , Miopia Degenerativa/terapia , Fotoquimioterapia/métodos , Adulto , Contagem de Células , Colágeno/metabolismo , Terapia Combinada , Substância Própria/efeitos dos fármacos , Substância Própria/metabolismo , Topografia da Córnea , Epitélio Posterior/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Miopia Degenerativa/tratamento farmacológico , Miopia Degenerativa/metabolismo , Miopia Degenerativa/cirurgia , Fármacos Fotossensibilizantes/uso terapêutico , Estudos Prospectivos , Refração Ocular/fisiologia , Riboflavina/uso terapêutico , Resultado do Tratamento , Raios Ultravioleta , Acuidade Visual/fisiologia , Adulto Jovem
7.
Eur J Ophthalmol ; 30(2): 392-395, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31766876

RESUMO

PURPOSE: To describe a new surgical technique, using a human amniotic membrane patch, in two cases of retinal detachment with paravascular retinal breaks over patchy chorioretinal atrophy in pathologic myopia, already underwent pars plana vitrectomy with the internal limiting membrane peeling for myopic foveoschisis. METHODS: Surgical technique description with surgical video. A 23-gauge pars plana vitrectomy was performed. A human amniotic membrane patch was implanted under the neuroretina to seal the posterior retinal break. Standard silicone oil tamponade was performed at the end of the surgery. The patients were positioned face down after the operation for the first week. Optical coherence tomography scans were used in the follow-ups. RESULTS: The 2 weeks postoperative optical coherence tomography showed a new tissue growth over the human amniotic membrane patch. The 3 months optical coherence tomography showed the new tissue entirely covering the human amniotic membrane plug. Visual acuity improved from 20/2000 (2 LogMAR) to 20/250 (1.1 LogMAR) 3 months after the operation in both patients. The silicone oil was extracted 2 months after surgery, and no recurrences were observed. The patient's visual acuity remained stable at 20/250 after the silicone oil extraction. CONCLUSION: In these complex cases, human amniotic membrane transplantation can be a valid option, when internal limiting membrane has already been peeled in previous surgeries, to seal the posterior retinal breaks over high myopic chorioretinal atrophy, with encouraging results.


Assuntos
Âmnio/cirurgia , Miopia Degenerativa/complicações , Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Vitrectomia/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miopia Degenerativa/cirurgia , Retina/patologia , Retinosquise/cirurgia , Estudos Retrospectivos , Óleos de Silicone/administração & dosagem , Tomografia de Coerência Óptica , Acuidade Visual
8.
Eur J Ophthalmol ; 30(3): 446-454, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30845834

RESUMO

OBJECTIVE: Report the outcomes of laser in situ keratomileusis (LASIK) for high myopia correction after long-term follow-up. METHODS: Retrospective, consecutive, clinical study including 70 eyes that underwent LASIK using a 500 Hertz (Hz) repetition rate excimer laser and femtosecond technology for flap creation. Visual, refractive, corneal aberrations, and correlation among the variables were evaluated during 3 years. In addition, 34 eyes were followed during 5 years. RESULTS: Significant improvement of 17 logMAR lines was observed in uncorrected vision at 5 years (p < 0.01). This was consistent with spherical equivalent reduction that came from mean preoperative -7.79 diopters (D) to 5 years postoperative -0.24 D (p < 0.01). Significant induction of primary spherical aberration and coma aberration was also found (p < 0.01) at 3 months with levels of 0.61 µm and 0.47 µm, respectively, with no further changes at 5 years (p > 0.05). Pearson correlation showed that the amount of high-order aberrations at 3 months postoperativeley was significantly correlated with the changes in the keratometry throughout the 5 years (delta K) (R2 0.242 p = 0.05). Finally, preoperative corneal asphericity showed an inverse correlation with the delta K (R2 -308 p = 0.01). CONCLUSIONS: Results from this study suggests that LASIK for high myopia correction using 500 Hz repetition rate excimer laser provides stable visual, refractive and aberrometric results after 5 years of follow-up. A more prolate cornea and the amount of higher-order aberrations induced after LASIK are factors that negatively impact in the long-term stability of the procedure.


Assuntos
Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Lasers de Excimer/uso terapêutico , Miopia Degenerativa/cirurgia , Adulto , Topografia da Córnea , Aberrações de Frente de Onda da Córnea/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Miopia Degenerativa/fisiopatologia , Refração Ocular/fisiologia , Reoperação , Estudos Retrospectivos , Retalhos Cirúrgicos , Resultado do Tratamento , Acuidade Visual/fisiologia , Adulto Jovem
9.
Eur J Ophthalmol ; 30(3): 462-468, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30845836

RESUMO

PURPOSE: To evaluate the vault change and anterior segment movement induced by mydriasis in moderate-to-high myopic eyes with implantable collamer lenses (ICL). SETTING: Shanghai, China. DESIGN: A prospective consecutive observational study. METHODS: A total of 45 eyes of 24 patients with ICL V4 implantation and 128 eyes of 65 patients with ICL V4c implantation were included and analyzed. Anterior chamber depth, posterior corneal endothelium-to-ICL distance, and vault before and after mydriasis were measured by Pentacam (Oculus, Wetzlar, Germany) at 1, 3, and 6 months after surgery. RESULTS: Significant vault increases and anterior chamber depth increases induced by mydriasis were noted in both ICL V4 and V4c groups at 1, 3, and 6 months postoperatively. The corneal endothelium-ICL distance increased significantly in eyes with implanted ICL V4c after mydriasis at 3 and 6 months. Moreover, mydriasis-induced vault increases were greater in the ICL V4 group than in the ICL V4c group at 3 and 6 months. In eyes with implanted ICL V4c, mydriasis-induced vault increases were significantly greater at 1 month than at 3 and 6 months. CONCLUSION: Mydriasis results in a general vault increase in eyes with implanted ICLs. The adjustment of the pressure equilibrium via the central hole of the ICL V4c has an important role in vault change. The mydriasis-induced vault increases tend toward stability after 3 months postoperatively. Mydriasis is relatively safe in eyes with ICL implantation.


Assuntos
Implante de Lente Intraocular , Midríase/fisiopatologia , Miopia Degenerativa/fisiopatologia , Miopia Degenerativa/cirurgia , Lentes Intraoculares Fácicas , Adolescente , Adulto , Câmara Anterior/patologia , Epitélio Posterior , Feminino , Humanos , Pressão Intraocular/fisiologia , Iridectomia/métodos , Iris/cirurgia , Lasers de Estado Sólido/uso terapêutico , Masculino , Microscopia Acústica , Miopia/fisiopatologia , Miopia/cirurgia , Estudos Prospectivos , Microscopia com Lâmpada de Fenda , Acuidade Visual/fisiologia , Adulto Jovem
10.
Eur J Ophthalmol ; 30(2): NP12-NP15, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30845840

RESUMO

PURPOSE: To describe the clinical features of a rare case of NBAS-SOPH-like mutations; to emphasize special aspects of the ocular and oro-facial regions. METHODS: Case report. CASE DESCRIPTION: We present a 5-year-old girl initially examined for her dysmorphic features, mental delay, strabismus, and high myopia. During the funduscopic examination, we observed optic atrophy with narrow thinned arterioles with the light brown reflex of the central retina. A genetic assessment revealed NBAS-SOPH like mutation. An assessment by a team of orthodontists defined typical characteristics. CONCLUSIONS: NBAS mutations can also cause complex disease with a broad clinical spectrum ranging from isolated recurrent acute liver failure (RALF) to a multisystemic phenotype. Due to the heterogeneity of the expressions, a multispeciality approach to this situation is recommended.


Assuntos
Miopia Degenerativa/genética , Proteínas de Neoplasias/genética , Estrabismo/etiologia , Pré-Escolar , Feminino , Humanos , Mutação , Atrofia Óptica/genética
11.
Vestn Oftalmol ; 135(5): 46-53, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714512

RESUMO

Peripheral defocus plays a significant role in the formation of refraction. Perifocal spectacles allow differentiating correction of central and peripheral refraction of the eye along the horizontal meridian and can correct or reduce peripheral hyperopia. PURPOSE: To study the long-term results of wearing perifocal spectacles on the refraction in children with progressive myopia. MATERIAL AND METHODS: Perifocal spectacles were assigned to children of 7-14 years old with progressive myopia from -1.0 to -6.0 D in terms of refractive spherical equivalent. The children were examined before the prescription of perifocal spectacles and after 6 months, 12-18 months, 2 years, 3 years and 4-5 years. We measured visual acuity, the character of vision, refractive error before and after cycloplegia, performed biomicroscopy, ophthalmoscopy and biometry. Peripheral refraction was studied at 15° and 30° points in the nasal (N15 and N30) and temporal (T15 and T30) meridians without correction and while wearing perifocal spectacles. RESULTS: In perifocal spectacles, in the 15° zone, 100% of the eyes formed myopic defocus, which averaged -0.05±0.1 D in T15°, -0.25±0.16 D in N15° and -0.44±0.03 D in T30°. In the N30° zone, the hypermetropic defocus decreased by 4 times and amounted to 0.38±0.03 D. The rate of progression of myopia decreased from 0.8 D of baseline values to 0.17 D at 4-5 years of follow-up. After 6 months of wearing perifocal spectacles, the refraction gain was -0.2±0.02 D (in the control group it was -0.38±0.04 D), after 12-18 months - (-)0.38±0.04 D (-0.63±0.09 D in the control group), after 2 years - (-)0,78±0,06 D (-1.18±0,15 D in the control group), after 3 years - (-)0.99±0.12 D (-1.65±0.20D in the control group). During the 4-5 years of the follow-up, the refractive error in the main group was -1.16±0.2 D, which is 60% less than in the control group (-1.95±0.2 D). CONCLUSION: Constant wearing of perifocal spectacles reduces the rate of myopia progression in children by 4.5 times compared with the initial rate, and by 1.6 times (by 60%) in comparison with the control group. Perifocal spectacles are recommended as optical means to slow the progression of myopia.


Assuntos
Hiperopia , Miopia Degenerativa , Adolescente , Criança , Olho , Óculos , Humanos , Refração Ocular
12.
Zhonghua Yan Ke Za Zhi ; 55(10): 721-725, 2019 Oct 11.
Artigo em Chinês | MEDLINE | ID: mdl-31607061

RESUMO

The concern of high myopia in adolescents is increasingly prominent, because of the high prevalence and early onset of myopia in younger children. High myopia increases the risk of various fundus complications, resulting in serious damage to the vision of the working population. The mechanisms underlying the fundus pathology in high myopia remain unknown, although some studies have indicated the initial thinning of the choroid during the myopia progression might count a lot. The thinning of the choroid would influence the blood supply of the retina and sclera and accelerate the progression of myopia to high myopia, inducing the pathologic changes of the fundus. Since the treatment for pathological myopia is limited and cannot reverse the already existed visual impairment, preventive measures are necessary, including the attempts to delay the onset of myopia, to retard progression from mild myopia to high myopia and to retard the pathological changes of high myopia. Future researches should strengthen the understanding of the characteristics of pathologic changes of myopia, establish a predictive index system and a health management system to monitor early pathological changes, and promote early detection and intervention, so as to prevent fundus complications related to high myopia in multiple ways and avoid blindness and visual impairment caused by pathological fundus changes of myopia. (Chin J Ophthalmol, 2019, 55:721-725).


Assuntos
Corioide/patologia , Miopia Degenerativa/patologia , Retina/patologia , Esclera , Adolescente , Criança , Fundo de Olho , Humanos , Esclera/irrigação sanguínea
13.
Zhonghua Yan Ke Za Zhi ; 55(10): 791-795, 2019 Oct 11.
Artigo em Chinês | MEDLINE | ID: mdl-31607068

RESUMO

Pathological myopia refers to high myopia with fundus pathological changes. Choroidal neovascularization is one of its serious complications, and also the main cause of visual loss. Currently, the first-line treatment is anti-VEGF treatment, with good efficacy, high safety, good prognosis, and other advantages of vision. Commonly used anti-VEGF drugs include bevacizumab, ranibizumab, aflibercept, and conbercept. The main treatment strategies include 1+pro re nata and 3+pro re nata, and the standard of REPAIR test is often used to evaluate the re-injection. This article reviews the advantages of anti-VEGF therapy, drug selection, treatment strategy, and re-injection criteria. (Chin J Ophthalmol, 2019, 55:791-795).


Assuntos
Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Miopia Degenerativa/complicações , Ranibizumab/uso terapêutico , Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Neovascularização de Coroide/etiologia , Humanos , Injeções Intravítreas , Ranibizumab/administração & dosagem , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual
15.
Middle East Afr J Ophthalmol ; 26(3): 181-183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31619910

RESUMO

An implantable collamer lens® (ICL) V4c model (STAAR Surgical, Monrovia, CA, USA) was placed in the eye of a 31-year-old male patient with high myopia followed by the development of malignant glaucoma. After failing medical treatment for 5 days, a noncomplicated pars plana vitrectomy and anterior hyaloidectomy succeeded in breaking the aqueous misdirection. Sixteen months later, intraoperative miotics were purposefully withheld from the ICL surgery in the fellow eye and malignant glaucoma did not develop. Even though the patient's visual acuity postoperatively was 20/20, OU, a single small atrophic iris patch in the affected eye resulted in slightly more halos and glare in mesopic conditions as compared to the fellow eye. Earlier surgical intervention may have prevented iris ischemia and iridocorneal touch with its subsequent iris atrophy and resulted in an even more favorable visual outcome. Withholding intraoperative miotics during ICL surgery appeared to be beneficial in this case.


Assuntos
Glaucoma/etiologia , Implante de Lente Intraocular/efeitos adversos , Mióticos/administração & dosagem , Lentes Intraoculares Fácicas , Adulto , Glaucoma/tratamento farmacológico , Humanos , Pressão Intraocular/fisiologia , Masculino , Miopia Degenerativa/cirurgia , Pupila/efeitos dos fármacos , Acuidade Visual/fisiologia , Vitrectomia
16.
Strabismus ; 27(4): 223-229, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31612771

RESUMO

PURPOSE: To evaluate success of nasal loop myopexy as a primary procedure in correcting the ocular deviation in primary position when combined with recession and resection procedure (R&R) in exotropia hypotropia complex in high myopia and to explore the probable cause for deviation. CASE REPORTS: We present a case series of three adult males with exotropia hypotropia complex and high myopia with large angle exotropia and hypotropia, with deflection of the courses of superior and medial recti seen intraoperatively. We performed a conventional recession and resection procedure, which was combined with a nasal loop myopexy between the superior rectus (SR) and medial rectus (MR) in the same session, under local anesthesia, to correct the deflected course of SR and MR; with the aim of correcting the deviation in primary position and improving ocular motility, mainly elevation in abduction. RESULTS: We present a case series of three adult males with exotropia hypotropia complex, who were operated between March 2017 and October 2017. In all the three cases described above, it was noted that the preoperative exotropia and hypotropia improved following the combination of nasal loop myopexy with a conventional recession and resection procedure, as shown by improvement in ocular deviation in the primary position (measured by prism bar cover test, PBCT). First patient improved from 50 prism exotropia with 16 prism hypotropia to 5 prisms exophoria and 6 prisms hypotropia in left eye. Second patient improved from 45 prism right exotropia and 10 prism hypotropia to 10 prisms exotropia and 6 prism hypotropia. Third patient improved from 40 prism left exotropia and 20 prisms hypotropia to 10 prism esotropia and 5 prisms hypotropia. Ocular motility showed no restriction following surgery in any of the gazes. Limitation of elevation in abduction, caused due to SR deflection, improved due to repositioning of SR and MR in their anatomical positions in all the cases. In the first patient elevation in abduction improved from -4 to -1; in the second and third patients, it improved from -2 to 0. None of the three adult patients experienced any side effects following the procedure. CONCLUSION: The combination of recession and resection procedures with nasal loop myopexy was found to be effective in correcting the ocular deviation and limitation to elevation in abduction by correcting the deflected course of superior rectus and medial rectus to result in an effective improvement of elevation in abduction. One case had an overcorrection of exotropia. There were no other major complications.


Assuntos
Exotropia/cirurgia , Miopia Degenerativa/complicações , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Adulto , Exotropia/fisiopatologia , Movimentos Oculares/fisiologia , Humanos , Masculino , Estudos Retrospectivos , Visão Binocular/fisiologia , Adulto Jovem
18.
Invest Ophthalmol Vis Sci ; 60(12): 4052-4062, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31560770

RESUMO

Purpose: High myopia (HM) is defined as a refractive error worse than -6.00 diopter (D). This study aims to update the phenotypic and genotypic landscape of nonsyndromic HM and to establish a biological link between the phenotypic traits and genetic deficiencies. Methods: A cross-sectional study involving 731 participants varying in refractive error, axial length (AL), age, myopic retinopathy, and visual impairment. The phenotypic traits were analyzed by four ophthalmologists while mutational screening was performed in eight autosomal causative genes. Finally, we assessed the clinical relevance of identified mutations under the guidance of the American College of Medical Genetics and Genomics. Results: The relationship between refractive error and AL varied in four different age groups ranging from 3- to 85-years old. In adult groups older than 21 years, 1-mm increase in AL conferred 10.84% higher risk of pathologic retinopathy (Category ≥2) as well as 7.35% higher risk of low vision (best-corrected visual acuities <0.3) with P values < 0.001. The prevalence rates of pathologic retinopathy and low vision both showed a nonlinear positive correlation with age. Forty-five patients were confirmed to harbor pathogenic mutations, including 20 novel mutations. These mutations enriched the mutational pool of nonsyndromic HM to 1.5 times its previous size and enabled a statistically significant analysis of the genotype-phenotype correlation. Finally, SLC39A5, CCDC111, BSG, and P4HA2 were more relevant to eye elongation, while ZNF644, SCO2, and LEPREL1 appeared more relevant to refracting media. Conclusions: Our findings shed light on how multiple HM-related phenotypes are associated with each other and their link with gene variants.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Comprimento Axial do Olho/patologia , Miopia Degenerativa/genética , Doenças Retinianas/diagnóstico , Baixa Visão/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Criança , Pré-Escolar , China/epidemiologia , Estudos Transversais , Análise Mutacional de DNA , Feminino , Estudos de Associação Genética , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Miopia Degenerativa/diagnóstico , Fenótipo , Adulto Jovem
19.
Asia Pac J Ophthalmol (Phila) ; 8(5): 366-370, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31513040

RESUMO

BACKGROUND: Myopia has become a global public health problem. High myopia is linked to pathologic myopia (PM). As the severity of myopia increases, excessive axial elongation of the globe exerts a biomechanical stretch on the posterior pole, followed by a series of retinopathy which can lead to marked visual impairment. Posterior scleral reinforcement (PSR) is the only way that may have the potential to prevent the progression of axial elongation. Some scholars expressed satisfaction with the efficacy and safety of PSR. In contrast, other surgeons had negative conclusions on the outcomes for the surgery. OBJECTIVES: The aims of this review are to provide an update on the current knowledge of posterior scleral reinforcement to prevent progression of high myopia and to discuss clinical trials examining the potential utility of PSR in treating this disease. METHODS: We searched Ovid MEDLINE, Embase, PubMed and China National Knowledge Infrastructure (CNKI) (all years to 1 July 2019). We also conducted a gray literature search and handsearched reference lists of included studies and pertinent review articles. RESULTS: 26 clinical trials were included. 20 trials were designed as only one eye of each patient had posterior scleral reinforcement surgery. After 3 to 5 years of follow-up, the results are very satisfactory. 6 randomized controlled trials, which have conservatively treated groups, showed statistically significant differences between the eyeball axial length progression in the study group and the control group, where surgery was not performed. Most clinical trials reached a positive influence. But the efficacy of different clinical trials varies greatly. CONCLUSIONS: PSR, is safe and effective to slowdown myopia progression, especially for high myopia.


Assuntos
Comprimento Axial do Olho/diagnóstico por imagem , Miopia Degenerativa/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Esclera/cirurgia , Acuidade Visual , Progressão da Doença , Humanos , Miopia Degenerativa/diagnóstico , Miopia Degenerativa/fisiopatologia
20.
Asia Pac J Ophthalmol (Phila) ; 8(5): 360-365, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31478936

RESUMO

PURPOSE: Atropine eye drops is an emerging therapy for myopia control. This article reviews the recent clinical trials to provide a better understanding of the use of atropine eye drops on myopia progression. METHODS: All randomized clinical trials of atropine eye drops for myopia progression in the literatures were reviewed. RESULTS: Atropine eye drops 1% conferred the strongest efficacy on myopia control. However, its use was limited by the side effects of blurred near vision and photophobia. ATOM 2 study evaluated 0.5%, 0.1%, and 0.01% atropine on 400 myopic children, and suggested that 0.01% is the optimal concentration with good efficacy and minimal side effects. Since then, the use of atropine eye drops has been transitioned from high-concentration to low-concentration worldwide. Recent Low-concentration Atropine for Myopia Progression (LAMP) study evaluated 0.05%, 0.025%, 0.01% atropine eye drops and placebo group in 438 myopic children. The study firstly provided placebo-compared evidence of low-concentration atropine eye drops in myopia control. Furthermore, both efficacy and side effects followed a concentration-dependent response within 0.01% to 0.05% atropine. Among them, 0.05% atropine was the optimal concentration to achieve best efficacy and safety profile. CONCLUSIONS: Low concentration atropine is effective in myopia control. The widespread use of low-concentration atropine, especially in East Asia, may help prevent the myopia progression for the high-risk children. Further investigations on the rebound phenomenon following drops cessation, and longer-term individualized treatment approach should be warranted.


Assuntos
Atropina/administração & dosagem , Miopia Degenerativa/tratamento farmacológico , Progressão da Doença , Relação Dose-Resposta a Droga , Humanos , Midriáticos/administração & dosagem , Miopia Degenerativa/fisiopatologia , Soluções Oftálmicas , Refração Ocular/efeitos dos fármacos , Refração Ocular/fisiologia
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