Patchy atrophy and lacquer cracks predispose to the development of choroidal neovascularisation in pathological myopia

Abstract

Aims: To determine the incidence and predisposing findings for choroidal neovascularisation (CNV) in a large series of highly myopic patients. Methods: The medical records of 218 consecutive patients (325 eyes) with myopic fundus changes in the macula were reviewed. The incidence of CNV during a follow up of at least 3 years of highly myopic patients and identification of predisposing findings for the development of myopic CNV were examined. Results: Among 325 highly myopic eyes examined, 33 eyes (10.2%) developed myopic CNV. The incidence was higher (34.8%) among the fellow eyes of patients with preexisting CNV than among eyes of patients without pre-existing CNV (6.1%). CNV developed in 3.7% with diffuse chorioretinal atrophy, in 20.0% with patchy atrophy, and in 29.4% with lacquer cracks. Conclusion: Approximately one in 10 highly myopic eyes developed myopic CNV in average 130.2 months. Patchy atrophy and lacquer cracks were shown to be important predisposing findings for CNV development.H igh myopia is a major cause of legal blindness in many developed countries.1-3 It affects 27% to 33% of all myopic eyes, corresponding to a prevalence of 1.7% to 2% in the general population of the United States. 4 In Japan, pathological or high myopia reportedly affects 6% to 18% of the myopic population, and around 1% of the general population. 5High myopia is associated with progressive and excessive elongation of the eyeball.6-10 As a result of excessive eyeball elongation, various funduscopic changes within the posterior staphyloma develop in highly myopic eyes.11-14 Among these myopic fundus lesions, macular choroidal neovascularisation (CNV) is the most common vision threatening complication of high myopia. [15][16][17] Despite the importance of CNV as a vision threatening complication, the incidence of myopic CNV has not yet been reported. Some previous reports described the prevalence of myopic CNV.6 7 18 For long term management of highly myopic patients, however, it is more important to know how frequently new CNV occurs in myopic eyes. Also, to our knowledge, there have been no studies to investigate the predisposing findings for the development of myopic CNV.In the present study, many highly myopic patients with myopic fundus changes in the macular lesion were followed, and examined for later development of myopic CNV. The incidence of myopic CNV was identified in these patients as well as possible predisposing findings for the development of myopic CNV. PATIENTS AND METHODSIn all, 218 consecutive patients (325 eyes) with high myopia were identified using clinical records from 1988 to 2001 in the high myopia clinic at Tokyo Medical and Dental University and were enrolled in the present study. Informed consent was obtained from all patients. Approval from the ethics committee of the university was obtained. Inclusion criteria for this study were (1) refractive error of −8D or more; (2) fundus changes typical of pathological myopia within 1 disc diameter (DD) from the fovea centralis; and (3) minimum follow up p...

Intravitreal bevacizumab for choroidal neovascularisation secondary to causes other than age-related macular degeneration

“…Nearly 10% of eyes with degenerative retinal findings consistent with high myopia develop CNV. 11 The precise pathogenesis of myopic CNV remains unclear. However, some authors have suggested that mechanical tissue strain caused by stretching may lead to the development of choroidal ischaemia, followed by atrophy of both the RPE and the overlying retina, and the subsequent release of growth factors.…”

Sekundärerkrankungen bei hoher Myopie

“…5 % hochmyoper Augen gefunden [27]. In einer prospektiven Erfassung über 10 Jahre entwickelten 10 % eine neue myope CNV (mCNV) [112]. [140].…”

Choroidal neovascularization in 36 eyes of children and adolescents

“…This may be because ageing, in addition to mechanical stretching of the eyeball, might be important for the development of predisposing factors such as RPE atrophy and lacquer cracks. 47 However, myopic CNV has been reported in children. [48][49][50] In our study, of the two patients with myopic CNV, one had coexisting osteogenesis imperfecta.…”