Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan.
Asia Pac J Ophthalmol (Phila). 2018 Nov-Dec;7(6):415-421. doi: 10.22608/APO.2018290. Epub 2018 Sep 26.
Visual impairment resulting from pathologic myopia is a serious issue worldwide. This is mainly due to the development of different types of myopic maculopathy. Despite being a major cause of visual impairment worldwide, myopic maculopathy was not consistently defined. To overcome this problem, in 2015 the Meta-Analysis for Pathologic Myopia Study Group proposed a simplified, uniform classification system for myopic maculopathy. Among several lesions of myopic maculopathy, myopic choroidal neovascularization (CNV) is one of the most common and severe vision-threatening complications. Recent large clinical trials have reported a good initial efficacy for visual acuity improvement by application of anti-vascular endothelial growth factor therapy for myopic CNVs. However, long-term clinical studies demonstrate a gradual decrease in the visual acuity gain and return to the baseline level due to the development of myopic CNV-related macular atrophy. Regarding visual impairment caused by advanced myopic chorioretinal atrophy, the only way to prevent blindness is to prevent myopia from developing or progressing at a young age before the axial length elongates extremely. As peripapillary diffuse atrophy in childhood may be an indicator of more advanced myopic chorioretinal atrophy in later life, some preventive measures should be considered in such children.
病理性近视导致的视力损害是一个全球性的严重问题。这主要是由于不同类型的近视性黄斑病变的发展。尽管近视性黄斑病变是全球视力损害的主要原因之一，但它并没有得到一致的定义。为了解决这个问题，2015 年病理性近视研究组提出了一种简化的、统一的近视性黄斑病变分类系统。在近视性黄斑病变的几种病变中，近视性脉络膜新生血管（CNV）是最常见和最严重的威胁视力的并发症之一。最近的大型临床试验报告了抗血管内皮生长因子治疗近视性 CNV 可显著提高视力的初始疗效。然而，长期的临床研究表明，由于近视性 CNV 相关的黄斑萎缩的发展，视力提高的幅度逐渐下降，最终回到基线水平。对于由晚期近视性脉络膜视网膜萎缩引起的视力损害，防止失明的唯一方法是在眼轴极度延长之前，在年轻时预防近视的发生或进展。由于儿童时期的视盘周围弥漫性萎缩可能是以后生活中更严重的近视性脉络膜视网膜萎缩的指标，因此应该考虑对这些儿童采取一些预防措施。
