Cilioretinal Arteries and Cilioretinal Veins in Eyes with Pathologic Myopia.

We investigated the clinical characteristics of cilioretinal arteries (CAs) and cilioretinal veins (CVs) in eyes with pathologic myopia. Ninety-five eyes with pathologic myopia and CAs were studied. The retrobulbar vessels from which the CAs originated were identified by indocyanine green angiography (ICGA). The results showed that 114 CAs were identified in the 95 eyes. ICGA showed that 60% of the CAs branched directly off the short posterior ciliary arteries (SPCAs) and 40% originated from the Zinn-Haller arterial circle (ZHAC). The SPCA-derived CAs tended to be located superiorly and served a large retinal area whereas the ZHAC-associated CAs tended to be located temporally and served mainly the macular area. In 15% of the 95 eyes, the CVs were observed to run parallel to the CAs. The CVs exited the eye at the same point where the CAs entered the eye. This study showed that CAs in eyes with pathologic myopia can be divided into those that are SPCA-derived and tend to emerge in the superior optic disc sector, and those that are ZHAC-associated and usually emerge temporally. An elongating peripapillary scleral flange in eyes with progressive axial myopia may lead to a change of chorioretinal vascular system.

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.

Characteristics of higher-order aberrations and anterior segment tomography in patients with pathologic myopia.

PURPOSE: To investigate prospectively the characteristics in the higher-order aberrations and anterior segment tomography in patients with pathologic myopia. METHODS: One hundred and twelve consecutive highly myopic patients (mean age 43.4 ± 9.3 years, spherical equivalent of refractive error ≥8 D and an axial length ≥26.5 mm) were studied. Thirty-seven emmetropic individuals (mean age 37.0 ± 14.5 years, spherical equivalent of refractive error ≤ ±1 D) were analyzed as controls. The ocular and cornea higher-order aberrations were measured using a Hartmann-Shack wavefront sensor (KR-1W; Topcon Corporation, Tokyo, Japan). The crystalline lens rise, the angle-to-angle, and the white-to-white values were measured using anterior segment OCT (SS-1000; Tomey Corporation, Nagoya, Japan). The mean curvature of the anterior corneal surface, the thickness at the thinnest central corneal point, the location of the central corneal point, the corneal volume, the anterior chamber volume, and the anterior chamber depth were measured using the Pentacam HR (Oculus, Inc., Wetzlar, Germany). RESULTS: The ocular total higher-order aberration for 4-mm pupil, the ocular spherical aberrations, and internal spherical aberration for 6-mm pupil were significantly higher in highly myopic eyes than in the emmetropic controls. The crystalline lens rise was significantly smaller in highly myopic eyes than in the emmetropic controls. The anterior chamber depth and the anterior chamber volume were significantly larger in highly myopic eyes than in the emmetropic controls. CONCLUSION: Highly myopic eyes had higher-order aberrations than emmetropic eyes because of the increasing internal aberrations.

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.

Detection of Zinn-Haller arterial ring in highly myopic eyes by simultaneous indocyanine green angiography and optical coherence tomography.

PURPOSE: To determine the intrascleral location of the circle of Zinn-Haller by simultaneous indocyanine green (ICG) angiography and enhanced-depth imaging optical coherence tomography (EDI-OCT) in highly myopic eyes. DESIGN: Retrospective, consecutive, observational case series. METHODS: Ninety-four eyes of 67 consecutive patients with pathologic myopia who underwent simultaneous ICG angiography and EDI-OCT examinations by Spectralis HRA-OCT, and whose Zinn-Haller ring was observed within the area of myopic conus by ICG angiography, were studied. The definition of pathologic myopia was a refractive error (spherical equivalent) <-8.00 diopters (D) or an axial length >26.5 mm. RESULTS: The EDI-OCT images showed cross-sections of the vessels that were identified in the ICG images as the circle of Zinn-Haller. The vessels were seen as a hyporeflective circle within the peripapillary sclera. An intrascleral course of the Zinn-Haller ring was clearly observed in adjacent serial OCT sections. The filling of the Zinn-Haller ring was from the short posterior ciliary arteries, and OCT also showed a continuous pathway from the retrobulbar short posterior ciliary arteries to the circle of Zinn-Haller. Centripetal branches were seen to run toward the optic nerve from the Zinn-Haller ring in 20 eyes by ICG and were confirmed by OCT in 4 eyes. CONCLUSIONS: The HRA-OCT images confirmed that the vascular structure surrounding the optic disc observed by ICG angiography had topographic features specific to the Zinn-Haller arterial ring by OCT. The in situ observation of the circle of Zinn-Haller by simultaneous ICG angiography and OCT is a useful method to examine the Zinn-Haller ring in eyes with pathologic myopia.