Long-term Pattern of Progression of Myopic Maculopathy A Natural History Study
Long-term Pattern of Progression of Myopic Maculopathy A Natural History Study
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DOI：
10.1016/j.ophtha.2009.11.003
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发表时间：
2010-08-01
期刊：
影响因子：
13.7
通讯作者：
Mochizuki, Manabu
中科院分区：
文献类型：
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作者：
Hayashi, Kengo;Ohno-Matsui, Kyoko;Mochizuki, Manabu
目的：研究近视性黄斑病变的长期进展模式，并确定每个进展阶段的视力预后。设计：回顾性，观察性病例系列。参与者：429例806眼高度近视患者的病历分析（屈光不正>-8.00D或眼轴>= 26.5mm），随访5-32年。参与者每年至少接受一次完整的眼科检查，包括最佳矫正视力、眼轴长度测量、荧光素血管造影和彩色眼底照相。双眼立体眼底镜检查确定后葡萄肿的存在和类型。近视性黄斑病变的类型包括方格状眼底、漆样裂纹、弥漫性脉络膜视网膜萎缩、斑片状脉络膜视网膜萎缩、脉络膜新生血管（CNV）和黄斑萎缩。没有患者接受任何类型的治疗maculopathy.Main结果措施：纵向长期进展模式和视力预后的每种类型的fundamentallesions.Results：在平均随访12.7年，327的806高度近视眼（40.6%）表现出进展的近视性黄斑病变。最常观察到的模式是从棋盘格状眼底发展为弥漫性萎缩和漆裂纹，在有漆裂纹的眼睛中宽度增加并进展为斑片状萎缩，弥漫性萎缩扩大，在弥漫性萎缩的眼睛中发展为斑片状萎缩，以及在斑片状萎缩的眼睛中萎缩区域的斑片扩大和融合。初始检查时眼底呈棋盘格状、漆样裂纹、弥漫性萎缩和斑片状萎缩的眼睛进展为CNV。CNV眼出现黄斑萎缩。斑片状萎缩的融合、CNV的发展和黄斑萎缩都导致显著的视力下降。一个后葡萄肿更频繁地观察到的眼睛，表现出进展从棋盘格眼底，弥漫性萎缩，斑片状萎缩比那些没有progress.Conclusions：这些研究结果表明，近视黄斑病变往往进展约40%的高度近视眼，和模式的进展影响视力预后。预防性治疗针对后葡萄肿应考虑防止视力损害所造成的近视maculopathy.Financial披露的进展：作者没有专有或商业利益的任何材料在本文中讨论。Ophthalmology 2010; 117：1595-1611（C）2010，美国眼科学会。
Objective: To investigate the long-term progression pattern of myopic maculopathy and to determine the visual prognosis of each progression stage.Design: Retrospective, observational case series.Participants: The medical records of 806 eyes of 429 consecutive patients with high myopia (refractive error more than -8.00 diopters [D] or axial length >= 26.5 mm) who were followed for 5-32 years were reviewed.Methods: Participants had complete ophthalmological examinations including best-corrected visual acuity, axial length measurements, fluorescein angiography, and color fundus photography, at least once a year. The presence and type of posterior staphyloma was determined by binocular stereoscopic ophthalmoscopy. The types of myopic maculopathy included tessellated fundus, lacquer cracks, diffuse chorioretinal atrophy, patchy chorioretinal atrophy, choroidal neovascularization (CNV), and macular atrophy. None of the patients had received any type of treatment for the maculopathy.Main Outcome Measures: The longitudinal long-term progression pattern and the visual prognosis of each type of fundus lesion.Results: During the mean follow-up of 12.7 years, 327 of the 806 highly myopic eyes (40.6%) showed a progression of the myopic maculopathy. The most commonly observed patterns were from tessellated fundus to the development of diffuse atrophy and lacquer cracks, an increase in the width and progression to patchy atrophy in eyes with lacquer cracks, an enlargement of the diffuse atrophy, and the development of patchy atrophy in eyes with diffuse atrophy, and an enlargement and fusion of patches of atrophic areas in eyes with patchy atrophy. Eyes with tessellated fundus, lacquer cracks, diffuse atrophy and patchy atrophy at the initial examination progressed to the development of CNV. Eyes with CNV developed macular atrophy. The fusion of patchy atrophy, the development of CNV, and macular atrophy all led to significant visual decreases. A posterior staphyloma was observed more frequently in eyes that showed progression from tessellated fundus, diffuse atrophy, and patchy atrophy than those without a progression.Conclusions: These findings indicate that myopic maculopathy tends to progress in approximately 40% of highly myopic eyes, and the pattern of progression affects the visual prognosis. Preventive therapy targeting posterior staphyloma should be considered to prevent the visual impairment caused by the progression of myopic maculopathy.Financial Disclosures: The authors have no proprietary or commercial interest in any of the materials discussed in this article. Ophthalmology 2010; 117: 1595-1611 (C) 2010 by the American Academy of Ophthalmology.