Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan; Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.
Ophthalmology. 2018 Jun;125(6):863-877. doi: 10.1016/j.ophtha.2017.12.005. Epub 2018 Jan 19.
To examine the progression pattern of myopic maculopathy.
Retrospective, observational case series.
Highly myopic patients who had been followed up for 10 years or more.
Using fundus photographs, myopic features were differentiated according to Meta-analysis of Pathologic Myopia (META-PM) Study Group recommendations.
Progression pattern of maculopathy.
The study included 810 eyes of 432 patients (mean age, 42.3±16.8 years; mean axial length, 28.8±1.9 mm; mean follow-up, 18.7±7.1 years). The progression rate of myopic maculopathy was 47.0 per 1000 eye-years. Within the pathologic myopia (PM) group (n = 521 eyes), progression of myopic maculopathy was associated with female gender (odds ratio [OR], 2.21; P = 0.001), older age (OR, 1.03; P = 0.002), longer axial length (OR, 1.20; P = 0.007), greater axial elongation (OR, 1.45; P = 0.005), and development of parapapillary atrophy (PPA; OR, 3.14; P < 0.001). Diffuse atrophy, found in 217 eyes without choroidal neovascularization (CNV) or lacquer cracks (LCs) at baseline, progressed in 111 (51%) eyes, leading to macular diffuse atrophy (n = 64; 64/111 or 58%), patchy atrophy (n = 59; 53%), myopic CNV (n = 18; 16%), LCs (n = 9; 5%), and patchy-related macular atrophy (n = 3; 3%). Patchy atrophy, detected in 63 eyes without CNV or LCs at baseline, showed progression in 60 eyes (95%), leading to enlargement of original patchy atrophy (n = 59; 59/60 or 98%), new patchy atrophy (n = 29; 48%), CNV-related macular atrophy (n = 13; 22%), and patchy-related macular atrophy (n = 5; 8%). Of 66 eyes with LCs, 43 eyes (65%) showed progression with development of new patchy atrophy (n = 38; 38/43 or 88%) and new LCs (n = 7; 16%). Reduction in best-corrected visual acuity (BCVA) was associated mainly (all P < 0.001) with the development of CNV or CNV-related macular atrophy and enlargement of macular atrophy.
The most frequent progression patterns were an extension of peripapillary diffuse atrophy to macular diffuse atrophy in diffuse atrophy, enlargement of the original atrophic lesion in patchy atrophy, and development of patchy atrophy in LCs. Main risk factors for progression were older age, longer axial length, and development of PPA.
研究近视性黄斑病变的进展模式。
回顾性、观察性病例系列。
接受了 10 年或以上随访的高度近视患者。
根据 Meta-analysis of Pathologic Myopia (META-PM) 研究组的建议，使用眼底照片对近视特征进行区分。
黄斑病变的进展模式。
本研究纳入了 432 例患者的 810 只眼（平均年龄 42.3±16.8 岁；平均眼轴长 28.8±1.9mm；平均随访时间 18.7±7.1 年）。近视性黄斑病变的进展率为每 1000 眼年 47.0。在病理性近视（PM）组（n=521 只眼）中，近视性黄斑病变的进展与女性（比值比[OR]，2.21；P=0.001）、年龄较大（OR，1.03；P=0.002）、眼轴较长（OR，1.20；P=0.007）、轴向伸长较大（OR，1.45；P=0.005）和脉络膜新生血管（CNV）旁萎缩（PPA；OR，3.14；P<0.001）的发展相关。在基线时无 CNV 或漆裂纹（LCs）的 217 只眼中发现弥漫性萎缩，其中 111 只（51%）眼进展，导致黄斑弥漫性萎缩（n=64；64/111 或 58%）、斑片状萎缩（n=59；53%）、近视性 CNV（n=18；16%）、LCs（n=9；5%）和斑片状相关的黄斑萎缩（n=3；3%）。在基线时无 CNV 或 LCs 的 63 只眼中，有 60 只眼（95%）出现进展，导致原有斑片状萎缩扩大（n=59；59/60 或 98%）、新的斑片状萎缩（n=29；48%）、CNV 相关的黄斑萎缩（n=13；22%）和斑片状相关的黄斑萎缩（n=5；8%）。在 66 只存在 LCs 的眼中，有 43 只眼（65%）出现进展，表现为新的斑片状萎缩（n=38；38/43 或 88%）和新的 LCs（n=7；16%）的发展。最佳矫正视力（BCVA）的下降主要与 CNV 或 CNV 相关的黄斑萎缩和黄斑萎缩的扩大有关（均 P<0.001）。
最常见的进展模式是在弥漫性萎缩中，PPA 向黄斑弥漫性萎缩的延伸；在斑片状萎缩中，原有萎缩病灶的扩大；在 LCs 中，斑片状萎缩的发展。进展的主要危险因素是年龄较大、眼轴较长和 PPA 的发展。
