Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113, Japan.
Ophthalmology. 2010 Aug;117(8):1595-611, 1611.e1-4. doi: 10.1016/j.ophtha.2009.11.003. Epub 2010 Mar 5.
To investigate the long-term progression pattern of myopic maculopathy and to determine the visual prognosis of each progression stage.
Retrospective, observational case series.
The medical records of 806 eyes of 429 consecutive patients with high myopia (refractive error more than -8.00 diopters [D] or axial length > or =26.5 mm) who were followed for 5-32 years were reviewed.
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.
The longitudinal long-term progression pattern and the visual prognosis of each type of fundus lesion.
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.
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.
探讨近视性黄斑病变的长期进展模式，并确定各进展阶段的视力预后。
回顾性、观察性病例系列。
对 429 例连续高度近视患者（屈光度>-8.00 屈光度[D]或眼轴长度>或=26.5mm）的 806 只眼进行了回顾性分析，这些患者接受了 5-32 年的随访。
参与者接受了全面的眼科检查，包括最佳矫正视力、眼轴测量、荧光素血管造影和眼底彩色照相，每年至少一次。双眼立体视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镶嵌眼底、漆裂纹、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。所有患者均未接受任何类型的黄斑病变治疗。
纵向长期进展模式和每种眼底病变的视力预后。
在平均 12.7 年的随访中，806 只高度近视眼中有 327 只（40.6%）出现了近视性黄斑病变的进展。最常见的表现模式是从镶嵌眼底发展为弥漫性萎缩和漆裂纹，漆裂纹眼的宽度增加并进展为斑片状萎缩，弥漫性萎缩扩大，弥漫性萎缩眼发展为斑片状萎缩，斑片状萎缩眼的萎缩区斑块扩大并融合。初始检查时有镶嵌眼底、漆裂纹、弥漫性萎缩和斑片状萎缩的眼进展为 CNV。有 CNV 的眼发展为黄斑萎缩。斑片状萎缩的融合、CNV 的发展和黄斑萎缩都导致了明显的视力下降。在表现出从镶嵌眼底、弥漫性萎缩和斑片状萎缩进展的眼中，后葡萄肿比没有进展的眼中更常见。
这些发现表明，近视性黄斑病变在大约 40%的高度近视眼中有进展趋势，进展模式影响视力预后。应考虑针对后葡萄肿的预防性治疗，以防止近视性黄斑病变进展导致的视力损害。
