Long-term Pattern of Progression of Myopic Maculopathy

Multimodal imaging including spectral-domain optical coherence tomography and confocal near-infrared reflectance for characterization of lacquer cracks in highly myopic eyes

“…The evidence of transitional changes as the SD-OCT scan moved from the lacquer cracks to the patchy atrophy indicates that patchy chorioretinal atrophy involves an area with greater thinning of the choroid than that which occurs in the area associated with lacquer cracks, and that NIR images show brighter reflectance in areas of patchy chorioretinal atrophy than in lacquer cracks. As indicated by other studies, 3,4,11 patchy chorioretinal atrophy is probably a more advanced phase of myopic maculopathy than lacquer cracks. Similar NIR hyperreflectance correlated to a lack of choroid was observed in eyes from the patients with choroideremia (Figure 4a).…”

“…4 Therefore, the early detection of lacquer cracks in highly myopic eyes is crucial, because their formation is considered to be the step immediately preceding the development of CNV (wet-type myopic maculopathy) and patchy chorioretinal atrophy (severe dry-type myopic maculopathy). 3,[5][6][7][8] Both myopic CNV and patchy chorioretinal atrophy are severe myopic maculopathies that result in irreversible visual loss.…”

Advances of optical coherence tomography in myopia and pathologic myopia

“…Based on long-term natural course study of eyes with pathologic myopia, three types of patchy atrophy were observed: patchy atrophy that develops from lacquer cracks, patchy atrophy that develops within the area of an advanced diffuse CRA, and patchy atrophy that can be seen along the border of the posterior staphyloma. 102 For the first two types, OCT images show a loss of photoreceptors, RPE, and inner choroid in the area of patchy atrophy in the macular area, while the inner retina appeared to be attached directly to the sclera. 48 Hence, despite the loss of outer retinal tissue, the inner retinal layer is maintained in the area of patchy atrophy.…”

Long-term outcome of intravitreal anti-vascular endothelial growth factor therapy with bevacizumab or ranibizumab as primary treatment for subfoveal myopic choroidal neovascularization

“…Seventeen (Figure 3). For the ranibizumab group, the mean number of injections was also 3.8 (range, [3][4][5][6]. Eleven (73.3%) eyes required only three initial intravitreal ranibizumab injections.…”

“…1,2 The visual prognosis is generally poor without treatment, as a substantial proportion of patients will have progression of myopic maculopathy resulting in significant visual loss. 3,4 Photodynamic therapy (PDT) with verteporfin has been used for treating myopic CNV in the past decade and studies have shown that PDT might reduce the risk of visual loss compared with placebo. 5,6 However, the long-term outcome of PDT is not favourable as patients generally had no improvement in mean visual acuity following treatment and the beneficial effect of PDT in preventing visual loss was no longer significant at 2 years.…”