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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shiwei Li ◽  
Tingting Li ◽  
Xiangning Wang ◽  
Xuan Cai ◽  
Bin Lu ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Posterior Vitreous Detachment ◽  
Natural Course ◽  
Rapid Progression ◽  
Progression Rate ◽  
Visual Prognosis ◽  
Posterior Staphyloma ◽  
Vitreous Detachment ◽  
Myopic Traction Maculopathy

Abstract 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.

scholarly journals Natural Course of Myopic Traction Maculopathy and Factors Influencing Progression and Visual Acuity

2021 ◽  
Author(s):  
Shiwei Li ◽  
Tingting Li ◽  
Xiangning Wang ◽  
Xuan Cai ◽  
Bin Lu ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Posterior Vitreous Detachment ◽  
Natural Course ◽  
Rapid Progression ◽  
Progression Rate ◽  
Visual Prognosis ◽  
Posterior Staphyloma ◽  
Vitreous Detachment ◽  
Myopic Traction Maculopathy

Abstract 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 (147 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, 58 of 147 eyes (39.5%) 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 = 0.0006). MTM with partial posterior vitreous detachment during the follow-up progressed more rapidly than MTM without (P = 0.0461). Patients with older age (>65 years), and defects in the ellipsoid zone (EZ) had worse BCVA at the last visit (P = 0.0281, and P = 0.0433). 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 = 0.0259, respectively).Conclusion: 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.

Evaluation and Management

2009 ◽  
Author(s):  
Daniel A. Brinton ◽  
Charles P. Wilkinson
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Posterior Vitreous Detachment ◽  
Anterior Segment ◽  
Careful Examination ◽  
Ocular Motility ◽  
Vitreous Detachment ◽  
Indirect Ophthalmoscopy ◽  
Field Defect

Evaluation of a patient for retinal detachment includes a thorough history and a complete ocular exam, including measurement of visual acuity, external examination, ocular motility testing, testing of pupillary reactions, anterior-segment biomicroscopy, tonometry, and binocular indirect ophthalmoscopy with scleral depression. Posterior-segment biomicroscopy, perimetry, and ultrasonography are also sometimes required. Rhegmatogenous retinal detachment is a diagnosis generally made by clinical examination of the retina alone, but a full history, ocular examination, and sometimes selected ancillary tests are also important parts of the evaluation (Figure 4–1). The symptoms of retinal detachment include fl ashes of light, new floaters, visual Field defect, decreased visual acuity, metamorphopsia, and rarely, defective color vision. The perception of light fl ashes, or photopsia, is due to the production of phosphenes by pathophysiologic stimulation of the retina. The retina is activated by light but is also capable of responding to mechanical disturbances. In fact, the most common cause of light fl ashes is posterior vitreous detachment. As the vitreous separates from the retinal surface, the retina is disturbed mechanically, stimulating a sensation of light. This perception is more marked if there are focal vitreoretinal adhesions. Generally, vitreous separation is benign and may almost be regarded as normal in the senescent eye. In approximately 12% of symptomatic posterior vitreous detachments, however, a careful search of the periphery reveals a tear of the retina. If the fl ashes are associated with floaters, it is wise to assume that a retinal tear exists, until proved otherwise. These symptoms demand a prompt and careful examination of the periphery with binocular indirect ophthalmoscopy and scleral indentation. The patient’s localization of the photopsia is of little value in predicting the location of the vitreoretinal pathology. If no breaks are evident in the first examination after symptomatic vitreous detachment, they rarely appear at a later date. If there is no associated hemorrhage or other pathologic condition, the patient needs counseling only. However, if pigment or blood is detected in the vitreous, a follow-up examination is often required. It is prudent to forewarn patients about the symptoms of retinal detachment. Flashes alone or floaters alone are less significant than if they occur together, in which case they are more likely to be associated with a retinal break.

scholarly journals Pneumatic induction of the posterior vitreous detachment - a minimally invasive method of treating vitreomacular traction syndrome

2017 ◽  
Vol 98 (5) ◽  
pp. 865-868
Author(s):  
D V Petrachkov ◽  
A V Zolotarev ◽  
P A Zamytskiy ◽  
E V Karlova ◽  
T A Podsevakina
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Posterior Vitreous Detachment ◽  
Vitreomacular Traction ◽  
Vitreous Detachment ◽  
Vitreomacular Traction Syndrome ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Best Corrected Visual Acuity

To study the efficacy of pneumatic induction of posterior vitreous detachment for the treatment of vitreomacular traction syndrome, the analysis of the results of surgical treatment of 10 patients (10 eyes) with vitreomacular traction syndrome was performed, among them 8 patients (8 eyes) had an accompanied immature age-related cataract and 2 patients (2 eyes) - pseudophakia. The average age of the patients was 64.1±4.6 years, among them 8 women and 2 men. The mean best corrected visual acuity on admission was 0.31±0.15, the average length of vitreomacular adhesion and retina thickness in the fovea by optical coherence tomography were 289.3±75.4 and 367.5±50.3 μm, respectively. Patients with pseudophakia underwent pneumatic induction of the posterior vitreous detachment, and patients with cataract underwent the same surgery in combination with phacoemulsification of the cataract and intraocular lens implantation. Within 1 month of follow-up, all patients had a complete posterior vitreous detachment and increased best corrected visual acuity. Intraocular pressure remained normal throughout the follow-up period in 9 out of 10 patients, 1 patient experienced hypertension on day 1 after the surgery, which required decompression during the gas expansion period. Further on, intraocular pressure was normalized and did not require therapy. Pneumatic induction of posterior vitreous detachment is an effective method of treatment of vitreomacular traction syndrome, which allows eliminating vitreomacular traction; the combination of pneumatic induction of the posterior vitreous detachment with phacoemulsification of cataract allows avoiding hypertension during and after operation and avoiding performing vitrectomy.

scholarly journals The Role of Internal Limiting Membrane as a Biomarker in the Evolution of Myopic Traction Maculopathy

2022 ◽  
Vol 8 ◽  
Author(s):  
Dong Fang ◽  
Jindi Su ◽  
Lu Chen ◽  
Shaochong Zhang
Keyword(s):  
Optical Coherence Tomography ◽  
Structural Changes ◽  
Posterior Vitreous Detachment ◽  
Internal Limiting Membrane ◽  
Progression Rate ◽  
Common Pattern ◽  
Myopic Traction Maculopathy ◽  
Study Inclusion

Purpose: To describe the longitudinal structural changes of myopic traction maculopathy (MTM) based on optical coherence tomography (OCT) and to detect biomarkers in the evolution of MTM.Methods: A retrospective study was conducted on patients with MTM as defined by OCT. A minimum follow-up of 6 months was necessary for study inclusion. The effects of comprehensive OCT-based structure on the evolution of MTM, the progression rates, and resolution rates of MTM were evaluated.Results: A total of 120 eyes (120 patients) were included with an average follow-up of 15.4 months. During the follow-up, MTM progressed in 32 eyes (26.67%). The most common pattern of progression observed was the increased extent of retinoschisis in 12 eyes. The multivariate analysis showed that the presence of MTM progression had a significant correlation with internal limiting membrane (ILM) detachment and retinoschisis involved the entire macula at baseline. Five eyes (4.17%) experienced MTM resolution, of which 2 eyes developed disruptions of detached ILM, two eyes developed disruptions of epiretinal membrane, and one eye developed partial posterior vitreous detachment. Eyes with foveal detachment showed the highest progression rate (41.67%) and highest resolution rate (16.67%) compared to the eyes with other foveal complications.Conclusion: ILM detachment is a risk factor for MTM progression and MTM resolution can occur after ILM disruption. These suggest that ILM may play an important role as a biomarker in the evolution of MTM.

An overview of age-related macular degeneration and its management using external beam radiotherapy

1999 ◽  
Vol 1 (1) ◽  
pp. 3-9
Author(s):  
John Newnham
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
External Beam Radiotherapy ◽  
Age Related Macular Degeneration ◽  
Western World ◽  
Rapid Progression ◽  
External Beam ◽  
Age Related ◽  
Radiation Induced

This paper aims to provide an overview of age related macular degeneration (ARMD) and its radiotherapy management.ARMD is already the leading cause of adult blindness in the western world. The neovascular form of ARMD is responsible for some 85% of blindness caused by ARMD as a whole. Its aetiology is unknown. The natural course of the disease is rapid progression from onset to disciform scarring and accompanying loss of visual acuity. Laser photocoagulation is only suitable for 10% of patients with neovascular ARMD. Initial studies using low dose fractionated external beam radiotherapy have demonstrated stable visual acuity over the range of 40–93% at short term follow-up. Only transient acute side effects have been observed. No radiation-induced retinopathy or vasculopathy have been observed. Common radiotherapy macula techniques are reviewed, field sizes examined and criteria for a simple macula technique proposed. A subset of patients with rapidly progressing neovascular ARMD may be candidates for rapid treatment starts. Although follow up times have been short, radiotherapy is a promising option for those patients facing imminent blindness due to rapidly progressive neovascular ARMD.

scholarly journals Indications and outcomes for intravitreal injection of C3F8 gas for symptomatic vitreomacular traction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Josef Guber ◽  
Celine Rusch ◽  
Ivo Guber ◽  
Hendrik P. N. Scholl ◽  
Christophe Valmaggia
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Adverse Events ◽  
Gas Injection ◽  
Posterior Vitreous Detachment ◽  
Vitreomacular Traction ◽  
Final Visit ◽  
Viable Option ◽  
Vitreous Detachment ◽  
Lower Success Rate

AbstractTo evaluate the indications and outcomes of perfluoropropane (C3F8) gas injection for symptomatic vitreomacular traction (VMT). A retrospective analysis of eyes with VMT treated with 0.3 mL of C3F8 gas was performed. Patients were not asked to posture after gas injection. In phakic patients, cataract surgery was performed simultaneously. Patients were examined after one week and one month postoperatively. Twenty-nine consecutive eyes of 26 patients with symptomatic VMT who underwent pneumatic vitreolysis were included. A complete posterior vitreous detachment was achieved in 18 eyes (62.1%) after a single gas injection at the final visit. The rate of posterior vitreous detachment was reduced significantly with the presence of epiretinal membrane (ERM) (p = 0.003). Three eyes formed a macular hole (MH) postoperatively and another eye developed a retinal detachment. Mean visual acuity increased significantly after one month (p < 0.008). Pneumatic vitreolysis is a viable option for treating VMT with few adverse events. Patient with concomitant ERM had a significantly lower success rate.

scholarly journals Long-Term Follow-Up of the Fellow Eye in Patients Undergoing Surgery on One Eye for Treating Myopic Traction Maculopathy

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Hui-Juan Xia ◽  
Wei-Jun Wang ◽  
Feng’E Chen ◽  
Ying Wu ◽  
Zhen-Yuan Cai ◽  
...  
Keyword(s):  
Axial Length ◽  
Initial Examination ◽  
Fellow Eye ◽  
Posterior Staphyloma ◽  
Chorioretinal Atrophy ◽  
Myopic Traction Maculopathy ◽  
Potential Risk Factors ◽  
The Difference ◽  
Fellow Eyes

Objective. To observe the fellow eye in patients undergoing surgery on one eye for treating myopic traction maculopathy.Methods. 99 fellow eyes of consecutive patients who underwent unilateral surgery to treat MTM were retrospectively evaluated. All patients underwent thorough ophthalmologic examinations, including age, gender, duration of follow-up, refraction, axial length, intraocular pressure, lens status, presence/absence of a staphyloma, and best-corrected visual acuity (BCVA). Fundus photographs and SD-OCT images were obtained. When feasible, MP-1 microperimetry was performed to evaluate macular sensitivity and fixation stability.Results. At an average follow-up time of 24.7 months, 7% fellow eyes exhibited partial or complete MTM resolution, 68% stabilized, and 25% exhibited progression of MTM. Of the 38 eyes with “normal” macular structure on initial examination, 11% exhibited disease progression. The difference in progression rates in Groups 2, 3, and 4 was statistically significant. Refraction, axial length, the frequency of a posterior staphyloma, chorioretinal atrophy, initial BCVA, final BCVA, and retinal sensitivity all differed significantly among Groups 1–4.Conclusions. Long axial length, chorioretinal atrophy, a posterior staphyloma, and anterior traction contribute to MTM development. Patients with high myopia and unilateral MTM require regular OCT monitoring of the fellow eye to assess progression to myopic pre-MTM. For cases exhibiting one or more potential risk factors, early surgical intervention may maximize the visual outcomes.

scholarly journals A Case of Giant Macular Hole Progression after Rupture of a Giant Retinal Pigment Epithelial Detachment

2019 ◽  
Vol 10 (2) ◽  
pp. 195-199
Author(s):  
Kosuke Nagaoka ◽  
Satoru Inoda ◽  
Hidenori Takahashi ◽  
Yusuke Arai ◽  
Yuji Inoue ◽  
...  
Keyword(s):  
Macular Hole ◽  
Retinal Pigment Epithelial ◽  
Retinal Pigment ◽  
Posterior Vitreous Detachment ◽  
Pigment Epithelial Detachment ◽  
Retinal Pigment Epithelial Detachment ◽  
Vitreous Detachment ◽  
Pigment Epithelial

We report a case of giant macular hole progression after rupture of giant retinal pigment epithelial detachment (PED). The patient was a 91-year-old man who had a giant PED in the left eye. He had bilateral hypermetropia (+2.00 dpt), and he had developed posterior vitreous detachment. The PED was 5,800 μm in diameter and 800 μm in height and ruptured during follow-up. A macular hole was formed, with a diameter of 400 μm, and the height of the PED had reduced to 360 μm. After 5 months, the macular hole expanded up to a diameter of 600 μm. Therefore, some cases of giant PED may lead to macular hole.

scholarly journals Foveal crack sign as a predictive biomarker for development of macular hole in fellow eyes of patients with full-thickness macular holes

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Olga Furashova ◽  
Egbert Matthé
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Macular Hole ◽  
Predictive Value ◽  
Progression Rate ◽  
Full Thickness ◽  
Vitreous Detachment ◽  
Macular Holes ◽  
Fellow Eyes

AbstractTo investigate the prevalence and predictive value of the foveal crack sign (FCS) in fellow eyes of patients with full-thickness macular holes (FTMH) regarding future macular hole (MH) formation. In a retrospective observational case series, 113 fellow eyes of 113 patients with FTMH have been observed during a mean follow-up time of 21 months. According to baseline SD-OCT images, patients were divided into 4 separate groups: patients with FCS and vitreous adhesion, patients with FCS and vitreous detachment, patients without FCS with vitreous adhesion, patients without FCS with vitreous detachment. Progression rate to MH formation, predictive value of FCS and of vitreous interface status were calculated and compared across the four groups. FCS was observed in 19 of 113 fellow eyes (17%) of patients with FTMH, 10 of them with progression to MH during the mean follow up time of 21 months. 2 other eyes with progression to MH showed no FCS at baseline. Progression rate was shown to be 77% (10 of 13 eyes) in patients with FCS and vitreous adhesion, 0% (none of 6 eyes) in patients with FCS and vitreous detachment, 4% (2 of 48 eyes) in patients without FCS with vitreous adhesion, 0% (none of 46 eyes) in patients without FCS with vitreous detachment. FCS had sensitivity of 83.3% (95% CI 50.9–97.1%) and specificity of 91.1% (95% CI 83.3–95.6%) in predicting MH formation, positive predictive value of FCS was 52.6% (95% CI 29.5–74.8%) and negative predictive value 97.9% (95% CI 91.8–99.6%). Having simultaneously FCS and vitreous adhesion showed 83.3% (95% CI 50.9–97.1%) sensitivity and 97.1% (95% CI 91.1–99.2%) specificity in predicting macular hole formation; positive predictive value was 76.9% (95% CI 46.0–93.8%) and negative predictive value was 98.0% (95% CI 92.4–99.7%). Fellow eyes of patients with FTMH with foveal crack sign are at a very high risk (77%) of FTMH development, as long as posterior vitreous adhesion is present.

Visual prognosis of posterior and combined persistent fetal vasculature

2019 ◽  
Vol 30 (2) ◽  
pp. 284-288 ◽  
Author(s):  
Veronique Promelle ◽  
Sophie Bryselbout ◽  
Solange Milazzo
Keyword(s):  
Visual Acuity ◽  
Vascular System ◽  
Cataract Extraction ◽  
Visual Prognosis ◽  
Visual Outcomes ◽  
Persistent Fetal Vasculature ◽  
Single Center Study ◽  
Bilateral Impairment ◽  
Anterior Posterior

Introduction: The persistent fetal vasculature refers to congenital anomalies of the globe resulting from the abnormal persistence of the hyaloid vascular system. It can present as anterior, posterior, or combined form. The aim of this study was to report the visual outcomes of posterior and combined forms of persistent fetal vasculature. Methods: This retrospective, single-center study included every patient referred to our outpatient clinic with a posterior or combined form of persistent fetal vasculature. The primary endpoint was the visual acuity of the impaired eye, or of the best eye if bilateral, at the end of follow-up. Results: In total, 18 eyes of 14 patients (10 males) were included. The combined form was the most prevalent (12 of 18 eyes), and 4 of 14 patients had bilateral impairment. The range of assessed visual acuity was from 20/2000 to 20/25. The best visual acuity in patients having undergone a surgical procedure was 20/63 (cataract extraction = 3, combined phacovitrectomy = 1). In patients who had been treated for amblyopia with patching, without surgery, the best visual acuity measured was 20/100 (5 patients). Among patients who had neither surgery nor patching therapy, there was one 63-year-old patient with a 20/25 visual acuity; the other ones had a low visual acuity of less than 20/200. All included eyes presented with nystagmus, amblyopia, and/or strabismus at the end of follow-up. Conclusion: The posterior and combined forms of persistent fetal vasculature are of poor visual prognosis. The severe or occulting presentations require surgery to obtain the same visual outcomes as the moderate forms treated for amblyopia with patching therapy.

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