Association Between Perforating Scleral Vessel and Myopic Maculopathy: A Cross-Sectional Study of a Chinese Cohort

Purpose: To investigate the association between perforating scleral vessel (PSV) and different types of myopic maculopathy (MM) in a highly myopic population.Methods: In total, 188 highly myopic eyes (117 participants) were enrolled. Each participant underwent detailed history taking and ocular examinations. Based on fundus photographs and optical coherence tomography, patients were subdivided into the non-MM group and MM group. Based on a new classification system (ATN), MM cases were classified as myopic atrophy maculopathy (MAM), myopic tractional maculopathy (MTM), and myopic neovascular maculopathy (MNM). The number of PSV and the macular choroidal thickness (mChT) were measured.Results: Compared with non-MM group, MM group was characterized by relatively larger age (48.40 vs. 32.34; p < 0.001), longer axial length (AL, 29.72 vs. 27.75, p < 0.001), thinner mChT (52.90 vs. 122.52; p < 0.001), and lower PSV counts (6.73 vs. 9.47, p ≤ 0.001). The non-MM group had higher PSV counts in total area (0–9 mm, 9.47 vs. 6.73, p < 0.001) and perifovea area (3–9 mm, 7.25 vs. 4.71, p < 0.001) compared to the MM group. Univariate and multivariate analyses showed that PSV count had no association with MAM (p = 0.2419) and MTM (p = 0.5678). Total PSV count [odds ratio (OR) 0.78, 95% CI 0.64–0.95, p = 0.0149] and perifovea PSV count (OR 0.80, 95% CI 0.65–0.98, p = 0.0299) were both protective factors for MNM. The stratified analysis revealed that in groups with AL <28 mm, or mChT <50 μm, or mChT ≥100 μm, or eyes with cilioretinal artery, PSV count had no significant association with MNM.Conclusion: Higher PSV counts in perifovea area (3–9 mm centered fovea) and total area (0–9 mm centered fovea) were protective factors for MNM, whereas PSV count had no association with MAM and MTM. These findings may provide novel insights into the mechanisms of pathologic myopia.

The RAP study, report 4: morphological and topographical characteristics of multifocal macular neovascularization type 3

Purpose To report on the morphological characteristics and regional distribution of multifocal macular neovascularization type 3 (mMNV3). Methods Twenty-two consecutive eyes of 21 patients with mMNV3 were included using multimodal imaging. The count and stage of lesions of all MNV types and the existence of exudate and hemorrhage were determined. Also, we addressed the regional distribution of MNV3 lesions between the superior-inferior and the nasal-temporal halves of the macula, and the range of the distance of the lesions from the central fovea. Furthermore, we explored the number of feeding vessels including the cilioretinal artery. Results We found 51 lesions in 22 eyes of 21 patients. They were bifocal in 16 (73%) eyes, trifocal in 5 (23%), and quadrifocal in one (4%). No lesion of MNV1 or 2 was found. Fifteen (68%), 2 (9%), and 16 (73%) eyes were associated with retinal hard exudate, subretinal pigment epithelium exudate, and intraretinal hemorrhage, respectively. Thirty (59%) lesions were located in the temporal half of the macula, whereas 21 (41%) were located nasally (p = 0.07). One (2%) lesion was closer than 500 µm, 49 (96%) between 500 and 1500 µm, and one (2%) between 1500 and 3000 µm. The lesions were supplied by one arteriole in one (4%) eye, two arterioles in 16 (73%) eyes, and 3 arterioles in 5 (23%) eyes. The CRA contributed as a feeding vessel in 5 (23%) eyes. Conclusion The multifocal variant of MNV3 has specific morphological and topographical characteristics. Multimodal imaging allows the understanding of the pathomorphological condition in more detail.

Cilioretinal Artery Occlusion as the Presenting Manifestation of Left Atrial Myxoma

Purpose: This work reports a case of left atrial myxoma presenting with cilioretinal artery occlusion. Methods: A case report is discussed. Results: A 57-year-old man was referred for acute vision loss in the left eye after a workup including electrocardiogram, magnetic resonance imaging of the brain without contrast, computed tomography angiography of the head and neck, erythrocyte sedimentation rate, and C-reactive protein had negative results. Examination revealed cilioretinal artery occlusion with visible emboli. Because an echocardiogram was not performed, the patient was referred to the emergency department. Echocardiogram revealed a large left atrial mass prolapsing into the left ventricle. The mass was excised, and pathology showed myxoma. Conclusions: This is the first case to our knowledge of isolated cilioretinal artery occlusion as the initial presentation of an atrial myxoma. Thorough and complete workup was crucial to averting further morbidity and mortality.

An Unusual Case of Concurrent Central Retinal Vein and Cilioretinal Artery Occlusion in a Healthy Patient

It is rare for young, healthy patients to have retinal venous or arterial occlusions and even rarer for both to occur in concert. Such an occurrence should prompt a rapid and extensive workup to prevent further complications. We present our patient, a 37-year-old Lebanese male, who reported a 3-day history of blurring of vision in his left eye. He had no medical or ocular history and is a nonsmoker. Examination of the left fundus revealed inferior macular edema and retinal whitening associated with tortuous retinal veins. He was diagnosed with a combined central retinal vein and cilioretinal artery occlusion. Emergency treatment was done for an acute arterial occlusion. Embolic and thrombotic causes were excluded with investigations. The only positive result was homozygosity for 677C>T mutation of the 5,10 methylenetetrahydrofolate reductase (MTHFR) enzyme gene. MTHFR enzyme breaks down homocysteine, which is atherogenic and prothrombotic. This mutation can lead to a prothrombotic state, precipitating this occurrence. In fact, the Lebanese population is known to have the highest incidence of such mutations, but there are surprisingly few reports on retinal vascular occlusions attributed to this. He was promptly treated with antiplatelet therapy, possibly preventing a full-blown central retinal vein occlusion. After 4 weeks, his vision improved to 6/6 bilaterally. Examination showed less tortuous veins, no more retinal whitening, resolution of macula edema and visual field defect. Hyperhomocysteinemia can be significant in patients without ischemic risk factors. It is vital to manage these patients promptly, preventing future sight and life-threatening events.