OBSERVATION OF VITREOUS FEATURES USING ENHANCED VITREOUS IMAGING OPTICAL COHERENCE TOMOGRAPHY IN HIGHLY MYOPIC RETINOSCHISIS

LONG-TERM EVOLUTION OF MYOPIC RETINOSCHISIS WITH A DOME-SHAPED MACULA AND PREDICTORS OF PROGRESSION AND VISUAL PROGNOSIS

PURPOSE

To study the long-term natural course of myopic retinoschisis (MRS) with a dome-shaped macula (DSM) and to identify the factors affecting its development and visual prognosis.

METHODS

In this retrospective case series study, we followed 25 MRS eyes with a DSM and 68 MRS eyes without a DSM for at least two years and observed changes in optical coherence tomography morphologic features and best-corrected visual acuity.

RESULTS

During the mean follow-up of 48.3 ± 13.24 months, the difference in the rate of MRS progression between the DSM and non-DSM groups was not significant ( P = 0.7462). In the DSM group, the patients whose MRS progressed were older and had a higher refractive error than those whose MRS was stable or improved ( P = 0.0301 and 0.0166, respectively). The patients whose DSM was located in the central fovea had a significantly higher progression rate than those whose DSM was located in the parafovea ( P = 0.0421). For all DSM eyes, BCVA did not decrease significantly in eyes with extrafoveal retinoschisis ( P = 0.2500), patients whose best-corrected visual acuity decreased more than two lines had a greater central foveal thickness initially than those whose best-corrected visual acuity decreased less than two lines during the follow-up period ( P = 0.0478).

CONCLUSION

A DSM did not delay the progression of MRS. The development of MRS in DSM eyes was associated with age, myopic degree, and DSM location. A higher schisis cavity predicted visual deterioration, and a DSM protected visual function in extrafoveal MRS eyes during the follow-up period.

Global trends and frontiers of research on pathologic myopia since the millennium: A bibliometric analysis

Background and purpose

Pathologic myopia (PM) is an international public health issue. This study aimed to analyze PM research trends by reporting on publication trends since 2000 and identifying influential journals, countries, authors, and keywords involved in PM.

Methods

A bibliometric analysis was performed to evaluate global production and development trends in PM since 2000 and the keywords associated with PM.

Results

A total of 1,435 publications were retrieved. PM has become a fascinating topic (with relative research interest ranging from 0.0018% in 2000 to 0.0044% in 2021) and a global public health issue. The top three countries with the highest number of publications were China, the USA, and Japan. The journals, authors, and institutions that published the most relevant literature came from these three countries. China exhibited the most rapid increase in the number of publications (from 0 in 2000 to 69 in 2021). Retina published the most papers on PM. Kyoko Ohno-Matsui and Tokyo Medical and Dental University contributed the most publications among authors and institutions, respectively. Based on keyword analysis, previous research emphasized myopic choroidal neovascularization and treatment, while recent hotspots include PM changes based on multimodal imaging, treatment, and pathogenesis. Keyword analysis also revealed that deep learning was the latest hotspot and has been used for the detection of PM.

Conclusion

Our results can help researchers understand the current status and future trends of PM. China, the USA, and Japan have the greatest influence, based on the number of publications, top journals, authors, and institutions. Current research on PM highlights the pathogenesis and application of novel technologies, including multimodal imaging and artificial intelligence.

Circulating Vitreous microRNA as Possible Biomarker in High Myopic Eyes with Macular Hole

High myopia is a major cause of irreversible visual impairment globally. In the present study, we investigated the microRNA (miRNA) profile in the vitreous of macular hole (MH) and high myopic MH. We performed miRNA analysis using TaqMan® Low Density Arrays (Thermo Fisher Scientific, Waltham, MA, USA) to investigate the circulating vitreous miRNA profile from patients with MH (axial length < 26.5 mm, n = 11) and high myopic MH (axial length ≥ 26.5 mm, n = 11) who underwent pars plana vitrectomy. The vitreous inflammatory cytokine signature was examined in high myopic MH eyes using a multiplex assay. A miRNA-Array analysis revealed that let-7c was significantly up-regulated and miR-200a was significantly down-regulated in high myopic MH eyes compared to those in MH eyes. The bioinformatics analysis for up-regulated miRNA targeted gene identified 23 pathways including mitogen-activated protein kinase (MAPK) and several inflammatory signaling pathways, whereas the bioinformatics analysis for down-regulated miRNA targeted genes showed 32 enriched pathways including phosphoinositide 3-kinase/protein kinase B (PI3K/AKT). The levels of inflammatory cytokines including IP-10, IFN-γ, and MCP-1 were significantly higher in the vitreous of high myopic MH eyes. These results suggest that specific miRNAs expressed in the vitreous may be associated with the pathological condition of high myopic MH and the above mentioned miRNAs may contribute to the development of inflammatory status in the vitreous of high myopic eyes.

Vitreomacular Interface Abnormalities in Myopic Foveoschisis: Correlation With Morphological Features and Outcome of Vitrectomy

Purpose: To compare the morphologic characteristics and response to surgery of myopic foveoschisis (MF) with different patterns of vitreomacular interface abnormalities (VMIAs).

Methods: In this observational case series, 158 eyes of 121 MF patients with epiretinal membrane (ERM) or vitreomacular traction (VMT) based on optical coherence tomography (OCT) were enrolled. All the eyes were divided into two groups by the pattern of VMIAs: ERM and VMT group. Sixty-one eyes underwent pars plana vitrectomy (PPV) and were followed up for at least 6 months. The morphologic characteristics based on OCT and the surgical outcome were evaluated.

Outcome: ERM and VMT were found in 47.47 and 52.53% of the cases, respectively. A higher rate of foveal detachment (61.4 vs. 26.7%; p < 0.001) and a higher rate of outer lamellar macular hole (45.8 vs. 21.3%; p = 0.001) were detected in the eyes with VMT compared with those with ERM. In contrast, a lower rate of inner lamellar macular hole (28.9 vs. 60.0%; p = 0.001) was detected in the eyes with VMT compared with those with ERM. The disruption of the external limiting membrane (ELM) was more common in the eyes with VMT than in those with ERM (45.8 vs. 21.3%; p = 0.001). PPV was performed in 61 eyes with a mean follow-up time of 23.55 ± 19.92 months. After surgery, anatomical resolution was achieved in 51 eyes (83.6%). At the final visit, the mean central foveal thickness (CFT) decreased significantly from 547.83 to 118.74 μm, and the mean LogMAR BCVA improved significantly from 0.92 to 0.57. The VMT group was associated with a higher proportion of eyes with visual acuity improvement postoperatively (p = 0.02) and had more a decrease of CFT (P = 0.007) compared with the ERM group.

Conclusion: In the eyes with MF, outer retinal lesions occurred more frequently in the eyes with VMT, whereas inner retinal lesions occurred more frequently in the eyes with ERM. Tangential force generated by ERM may act as a causative factor for the inner retinal lesions in MF, and inward-directed force resulting from VMT may act as a causative factor for outer retinal lesions in MF.

Inter-Eye Comparison in Highly Myopic Patients with Unilateral Myopic Traction Maculopathy

PURPOSE

To evaluate the risk factors for myopic traction maculopathy (MTM) through inter-eye comparisons of asymmetric ocular features in patients with unilateral MTM.

MATERIALS AND METHOD

Highly myopic patients with unilateral MTM were enrolled in the study. The results of comprehensive ophthalmologic examinations, color fundus images, and optical coherence tomography (OCT) were reviewed. MTM and myopic atrophic maculopathy was evaluated according to the ATN classification system. The status of the posterior vitreous detachment (PVD), posterior precortical vitreous pocket, vitreoretinal interface abnormalities, posterior staphyloma height (PSH), and the location of the protrusion of the sclera were assessed through OCT.

RESULTS

Among the 54 eyes of 27 patients 48.89 ± 12.78 years of age, the affected eyes had worse best-corrected visual acuity, a longer axial length (AXL), greater PSH, and higher rates of posterior staphylomas, vitreovascular traction and epiretinal membranes (ERMs) than the fellow eyes (P < .001; P < .001; P < .001; P = .010; P = .002; P < .001). Thirteen cases present obvious anisometropia with an inter-eye AXL difference of more than 1 mm. In the 14 cases without obvious anisometropia, the eyes with MTM still had longer AXL, greater PSH and a higher ERMs rate than the fellow eyes (P = .039; P = .017; P = .001). Besides, in the 7 cases with an inter-eye AXL difference of less than 1 mm and asymmetrical stages of PVD, 5 cases with greater PVD in the affected eyes. Multiple risk factors coexisted in 96% of cases.

CONCLUSIONS

In patients with unilateral MTM, a longer AXL, greater PSH, posterior staphyloma, vitreovascular traction, and ERMs were the main factors contributing to the occurrence of MTM. The process of PVD might involve in MTM development.

Natural course of myopic traction maculopathy and factors influencing progression and visual acuity

Background

To describe the natural course of myopic traction maculopathy (MTM) and determine predictive factors for its progression and visual prognosis.

Methods

This retrospective observational study included 113 MTM patients (113 eyes). Best-corrected visual acuity (BCVA) measurements and optical coherence tomography findings were recorded.

Results

Over a mean follow-up of 38.2 ± 11.1 months, 49 of 113 eyes (43.4 %) progressed. The progression rate of outer schisis prominently located in the fovea or posterior staphyloma was significantly higher than that of outer schisis prominently located in paravascular areas (P = 0.0011). MTM with partial posterior vitreous detachment during the follow-up progressed more rapidly than MTM without (P = 0.0447). Patients with older age (> 65 years), without domed-shaped macula and with defects in the ellipsoid zone (EZ) had worse BCVA at the last visit (P = 0.0416, P = 0.0494and P = 0.0130). Multiple linear regression analysis showed that BCVA and defects in the EZ at baseline were significantly associated with the final BCVA (P < 0.0001 and P = < 0.0001, respectively).

Conclusions

MTM has a high possibility for progression. Outer schisis located predominantly in the fovea or posterior staphyloma or with partial posterior vitreous detachment exhibits rapid progression. The integrity of the EZ is related to visual prognosis.

Morphological Characteristics Predict Postoperative Outcomes After Vitrectomy in Myopic Traction Maculopathy Patients

BACKGROUND AND OBJECTIVES

To provide the surgical indication for patients with myopic traction maculopathy (MTM) by investigating the postoperative outcomes after vitrectomy among different types of morphological characteristic groups.

PATIENTS AND METHODS

This was a retrospective cohort study that included patients (37 eyes) diagnosed with MTM at a single institution. All 37 eyes from 37 patients with MTMs were classified into three groups: foveal retinoschisis (FS), lamellar macular hole (LMH), and foveal retinal detachment (FRD). The ratios of anatomic recovery, central retinal thickness (CRT), and best-corrected visual acuity (BCVA) were statistically analyzed among the three groups preoperatively and at 1, 3, 6, and 12 months after vitrectomy.

RESULTS

Anatomical recovery could be found in all patients of the FS group at 6 months postoperatively and in the LMH group at 12 months postoperatively. Only 83.33% patients in the FRD group showed anatomic recovery until 12 months. The time taken for CRT to reduce to 200 µm was gradually increased between the FS, LMH, and FRD groups. Postoperative BCVA was better in the FS group than the LMH and FRD groups (P < .05), but the LMH and FDR groups had no difference (P ≥ .05) at any point. The visual acuity was significantly improved in the FS group (P < .01) and FRD group (P = .018), but not in the LMH group (P = .196) at 12 months postoperatively.

CONCLUSIONS

The FS group achieved anatomical recovery in the shortest time and had the best postoperative BCVA. FRD patients could get visual gain but need too much time for the anatomical recovery. LMH patients experienced anatomic success with surgery, but not in BCVA. Early surgery might be considered for eyes at FS prior to the occurrence of LMH or FRD. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:574-582.].

Posterior pole retinotomy for treatment of recurrent macular hole retinal detachment in highly myopic eyes: a pilot study

BACKGROUND

To investigate the feasibility and efficacy of posterior pole retinotomy to treat recurrent macular hole retinal detachment (MHRD) in highly myopic patients.

METHODS

We performed a retrospective study and reviewed the medical records in our hospital between January 1, 2016 and December 31, 2018. Highly myopic patients who received posterior pole retinotomy with silicone oil tamponade for their recurrent MHRD after pars plana vitrectomy were included in the analysis. Postoperative retinal reattachment, best-corrected visual acuity (BCVA), macular hole closure, and complications were evaluated.

RESULTS

There were 11 patients (11 eyes) included in this study. All retinas were reattached. Silicone oil was successfully removed from all eyes 1.5-3 months after the surgery. Macular holes were completely closed in three eyes and remained flat open in eight eyes. The BCVA of all eyes improved significantly at 12 months after surgery (logarithm of the minimal angle of resolution, pre vs. postoperatively, 1.87 ± 0.44 vs. 1.15 ± 0.24, P < 0.05). None of the patients had complications such as endophthalmitis, fundus hemorrhage, retinal redetachment, and proliferative vitreoretinopathy.

CONCLUSION

Posterior pole retinotomy is a safe and effective surgery to treat recurrent MHRD after pars plana vitrectomy in highly myopic patients.

Volumetric Optical Imaging and Quantitative Analysis of Age-Related Changes in Anterior Human Vitreous

Purpose

The purpose of this study was to characterize age-related changes in anterior human vitreous with 3-D swept source optical coherence tomography (SS-OCT) and evaluate associations with axial length (AL) and contrast sensitivity function (CSF).

Methods

There were 49 phakic eyes in 49 patients (40.0 ± 19.3 years) had 3-D volumetric scanning of the lens and retrolental vitreous with SS-OCT at 1050 nm. OCT-derived indices of vitreous optical density (VOD), vitreous opacification ratio (VOR), and lens optical density (LOD) were correlated with AL and double-pass assessment of retinal point spread function (Objective Scatter Index [OSI]). CSF was measured using an adaptive-optics visual simulator (area under log-log contrast sensitivity function [AULCSF]).

Results

Vitreous SS-OCT detected gel vitreous, liquefied lacunae, Berger's space, retrolental laminae, and fibrous opacifications. VOD, VOR, and LOD showed high reproducibility (intraclass correlation coefficients 0.968, 0.975, and 0.998, respectively). VOD was highly correlated with VOR (Pearson's R = 0.96, P < 0.000001). VOD, VOR, and LOD correlated with age (R = 0.48, 0.58, and 0.85, P < 0.001 for each). VOR and LOD correlated with OSI (R = 0.36, P = 0.0094, and R = 0.36, P = 0.0096, respectively). VOR correlated negatively with AULCSF (R = −0.53, P < 0.00009), which was related to OSI. Myopic eyes had higher OSI than nonmyopic eyes (P = 0.0121), consistent with correlation between OSI and AL (R = 0.37, P = 0.0091). Multivariable regression confirmed these findings.

Conclusions

SS-OCT visualized microstructural features of anterior human vitreous, where opacification is associated with increased light scattering and CSF degradation. SS-OCT enables high-resolution optical evaluation of vitreous opacities.

Posterior Vitreous Detachment in Highly Myopic Patients

Purpose

We compared the change in the state of posterior vitreous detachment (PVD) between highly myopic eyes and non-highly myopic eyes using age- and sex-matched patients.

Methods

Six hundred eyes of 600 patients with high myopia (axial length > 26.0 mm) or without high myopia were enrolled into each of six age categories with 50 eyes each: (1) 20 to 29 years, (2) 30 to 39 years, (3) 40 to 49 years, (4) 50 to 59 years, (5) 60 to 69 years, and (6) 70 to 79 years. The PVD status was evaluated using swept-source optical coherence tomography and classified into five stages: 0 (no PVD), 1 (paramacular PVD), 2 (perifoveal PVD), 3 (peripapillary PVD), and 4 (complete PVD).

Results

In the high myopia and non-high myopia groups, the mean PVD stage increased significantly with the age category (P < 0.0001). The PVD stage was significantly greater in the high myopia group than in the non-high myopia group in all age categories (P ≤ 0.0395). In the age groups of patients 50 to 59 years old and 60 to 69 years old, complete PVD was detected in 54.0% and 73.9% of eyes, respectively, in the high myopia group and in 14.0% and 44.0% of eyes, respectively, in the non-high myopia group. Abnormal PVD characteristics of pathologic myopia were detected in 1.7% of eyes in the high myopia group.

Conclusions

We precisely revealed, using age- and sex-matched patients, that partial PVD, including paramacular, perifoveal, and peripapillary PVD, and complete PVD develop at a significantly younger age in highly myopic eyes compared with non-highly myopic eyes, suggesting that PVD-related retinal pathologies occur younger in highly myopic patients.

Characteristics of Posterior Precortical Vitreous Pockets and Cloquet’s Canal in Patients with Myopia by Optical Coherence Tomography

Purpose

To describe the morphological features of posterior precortical vitreous pockets (PPVP) and Cloquet's Canal in patients with myopia using swept-source optical coherence tomography (SS OCT).

Methods

A total of 96 eyes of 51 volunteers (range, 5-18 years) were enrolled in this study, and all individuals underwent OCT (Optovue Inc., Fremont, CA, USA) examinations. From the collected PPVPs images, the widths and heights of the PPVPs were measured, and connections between PPVPs and Cloquet's Canal were identified. The PPVPs widths and heights, width:height ratios and proportions of connections were compared among different age (5-8, 9-14, 15-18 years), axial length (AL; 21-23, 23-25, 25-29 mm) and myopia groups (hyperopia, low to moderate myopia, high myopia); the group data were analyzed to determine their relationship with myopia.

Results

PPVPs were identified in 89 of 96 eyes; 6 eyes were excluded for poor image quality. The PPVPs width was positively correlated with age, especially in the low to moderate myopia group (F = 7.715, P = 0.001). There was a significant difference in the PPVPs height between the refractive error groups in the 9 to 14 years group (F = 4.905, P = 0.005). The PPVPs width:height ratio was different among the refractive error groups in the 9 to 14 years group (F = 3.335, P = 0.041) and among the different age groups in the low to moderate myopia group (F = 6.077, P = 0.004). A total of 22 eyes (22.4%) were identified as having a connection between the PPVP and Cloquet's Canal. The connections began to increase with AL at 5 to 8 years (χ2 = 7.363, P = 0.025).

Conclusions

PPVPs existed in most myopia patients from 5 to 18 years old. PPVPs width was positively correlated with age, especially in the low to moderate myopia group. PPVPs height decreased in the 9 to 14 years group with myopia. An imbalance in the horizontal and vertical enlargement of PPVP was the main feature in the 9- to 14-year-old group with myopia. The connections between the PPVP and Cloquet's Canal were associated with AL extension in the 5- to 8-year-old group.