Optical coherence tomography angiography for choroidal neovascularization in pathological myopia and neovascular age-related macular degeneration in combination with axial myopia in comparative analysis

Background. Optical coherence tomography angiography (OCTA) is currently an important method of visualization and assessment of fundus pathology in various diseases. The study of combined pathologies is not well covered.The aim: to compare OCTA features during choroidal neovascularization (CNV) in pathological myopia (PM) and in neovascular age-related macular degeneration in combination with axial myopia (nAMD + M) against the background of anti-VEGF therapy.Materials and methods. A prospective study included 70 eyes with active CNV. Comparative analysis of parameters was carried out between two groups: with PM – 47 eyes; with nAMD + M – 23 eyes.Results. 4 OCTA patterns were established in both groups: dense, loose, mixed and unidentifi able. With PM, dense pattern was found in 28 (59.57 %) eyes, loose pattern – in 16 (34.04 %), mixed pattern– in 2 (4.26 %), unidentifi able pattern – in 1 (2.13 %). In the nAMD + M group, dense pattern was rare – in 1 (4.35 %) eye, loose pattern – in 7 (30.44 %), mixed pattern – in 9 (39.13 %), unidentifi able pattern – in 6 (26.08 %). The fi rst group was characterized by a dense pattern that was found at a younger age, the second group was characterized by dense and mixed patterns. The greatest area and density of CNV were found with a loose pattern in both groups (p < 0.05). The observation period until the stabilization of CNV was achieved was longer in the loose and mixed patterns in the PM group, and in the loose and unidentifi able – in the nAMD + M group (p < 0.05). Loose and unidentifi able patterns require more injections. The halo was determined by the presence of intraretinal fluid in the retina. Conclusion. OCTA showed common features and distinctive features in the course of CNV in patients with PM and nAMD + M during anti-VEGF therapy. OCTA can be useful in assessing CNV activity and predicting the eff ect of treatment.

Axial length and its associations in the Ural Very Old Study

To assess the distribution of axial length as surrogate for myopia and its determinants in an old population, we performed the Ural Very Old Study as a population-based cohort study. Out of 1882 eligible individuals aged 85 + years, the Ural Very Old Study performed in an urban and rural region in Bashkortostan/Russia included 1526 (81.1%) individuals undergoing ophthalmological and medical examinations with sonographic axial length measurement. Biometric data were available for 717 (47.0%) individuals with a mean age of 88.0 ± 2.6 years (range 85–98 years; 25%). Mean axial length was 23.1 ± 1.1 mm (range 19.37–28.89 mm). Prevalences of moderate myopia (axial length 24.5–< 26.5 mm) and high myopia (axial length ≥ 26.5 mm) were 47/717 (6.6%; 95% CI 4.7, 8.4) and 10/717 (1.4%; 95% CI 0.5, 2.3), respectively. In multivariable analysis, longer axial length was associated (coefficient of determination r2 0.25) with taller body height (standardized regression coefficient beta:0.16;non-standardized regression coefficient B: 0.02; 95% confidence interval (CI) 0.01, 0.03; P < 0.001), higher level of education (beta: 0.12; B: 0.07; 95% CI 0.02, 0.11; P = 0.002), and lower corneal refractive power (beta: − 0.35; B: − 0.23; 95% CI − 0.28, − 0.18; P < 0.001). Higher prevalence of moderate myopia, however not of high myopia, was associated with higher educational level (OR 1.39; 95% CI 1.09, 1.68; P = 0.007) and lower corneal refractive power (OR 0.77; 95% CI 0.63, 0.94; P = 0.01). In this old study population, prevalence of moderate axial myopia (6.6% versus 9.7%) was lower than, and prevalence of high axial myopia (1.4% versus 1.4%) was similar as, in a corresponding study on a younger population from the same Russian region. Both myopia prevalence rates were higher than in rural Central India (1.5% and 0.4%, respectively). As in other, younger, populations, axial length and moderate myopia prevalence increased with higher educational level, while high myopia prevalence was independent of the educational level.

An Open Labelled Comparative Clinical Study to Evaluate the Effect of Go-Ghrita Tarpana and Triphala-Ghrita Tarpana on Antero-Posterior Diameter in Axial-Myopia

Background and Objective: Axial-myopia is characterized by blurriness of vision for distance caused by increased in A-P diameter. Usual treatment for myopia is optical correction by optical glass and contact lens. To restore distance vision, surgical intervention like, LASIK is adopted, which has complications like dry eye syndrome and astigmatism. The Ayurvedic approach of the disease mainly concentrates on treating the disease and preventing the progression of the disease. There are many hypothetical theories regarding mode of action of Tarpana on Myopia and Timira. In this study, an attempt is made to observe the effect of Tarpana on A-P diameter of eyeball and to know the difference between Tarpana by plain Go-Ghrita and Triphala Ghrita. Materials and Methods: 20 patients of Group A, were treated with Go-Ghrita Tarpana (two sittings of 7 days each, with the gap of 14 days) and in Group B, 20 patients were treated with Triphala-Ghrita Tarpana (two sittings of 7 days each, with the gap of 14 days). Results: The data of both the groups were collected according to the objective and subjective parameters and analyzed using the most appropriate statistical test (repeated measures of ANOVA, Bonferroni Test and Mann- Whitney U Test). The efficacy is statistically significant within the group at P <0.001and statistically insignificant between the groups at P >0.05 among all the parameters. Interpretation and Conclusion: On comparison of Go-Ghrita Tarpana with Triphala-Ghrita Tarpana, both have an equal effectiveness on distant vision, Optical correction and A-P diameter.

Macula structural and vascular differences in glaucoma eyes with and without high axial myopia

AimsTo assess the thickness of various retinal layers, and the superficial vessel density (sVD) in the macula of glaucomatous eyes and their associations with axial length (AL) and visual field mean deviation (VFMD) to identify parameters useful for glaucoma management in myopic eyes.Methods248 glaucoma patients (401 eyes) participating in the Diagnostic Innovations in Glaucoma Study observational cohort representing 3 axial myopia groups (non-myopia: n=146 eyes; mild myopia: n=208 eyes; high myopia (AL>26 mm): n=47 eyes) who completed macular OCT and OCT-Angiography imaging were included. The cross-sectional associations of AL and VFMD with the thickness of the ganglion cell inner plexiform layer (GCIPL), macular retinal nerve fiber layer (mRNFL), ganglion cell complex (GCC), sVD and macular choroidal thickness (mCT) were evaluated.ResultsThinner Global GCIPL and GCC were significantly associated with worse VFMD (R2=35.1%; and R2=33.4%; respectively p<0.001), but not with AL (all p>0.350). Thicker mRNFL showed a weak association with increasing AL (R2=3.4%; p=0.001) and a positive association with VFMD (global R2=20.5%; p<0.001). Lower sVD was weakly associated with increasing AL (R2=2.3%; p=0.016) and more strongly associated with more severe glaucoma VFMD (R2=31.8%; p<0.001). Thinner mCT was associated with increasing AL (R2=17.3% p<0.001) and not associated with VFMD (P=0.262). mRNFL was thickest while mCT was thinnest in all sectors of high myopic eyes.ConclusionsGCIPL and GCC thinned with increasing severity of glaucoma but were not significantly associated with axial length. GCIPL and GCC thickness may be useful clinical parameters to identify glaucoma in myopic eyes.

Diagnostic difficulties of myopic staphyloma

Purpose. Comparative analysis efficiency of diagnostic of myopic staphylomas using optical coherence tomography (OCT) with scan protocols different lengths. Material and methods. A 52-year-old patient with high axial myopia with myopic staphyloma was examined. Profound ophthalmological examination was carried out using OCT of the posterior pole of the eye using scans protocols of various lengths, ultrasound ocular echography. The presence and localization of scleral staphyloma was assessed. Results. When examining the posterior pole of the eye using 12 mm linear OCT scanning, no signs of staphyloma were detected in both eyes. Radial OCT scans 10 mm in length, 3D OCT scans size 12×9 mm scan made it possible to suspect the presence of large macular myopic staphyloma. Examination of patient using 16.5 mm linear OCT scanning revealed distinct prolapse of the posterior pole of the eye, capturing the optic disk and the macular area in both eyes. Ultrasound B-scan confirmed the presence of staphyloma of the posterior pole of the eye in both eyes. Conclusions. 1. To identify the presence and localization of myopic staphyloma, the most informative method is 16.5 mm OCT scanning. 2. For the diagnosis of myopic staphilomas, it is possible to use 12 mm OCT scanning. Key words: optical coherence tomography, myopia, myopic staphyloma, scleral staphyloma.

A novel variant in the TSPAN12 gene-presenting as unilateral myopia, pediatric cataract, and heterochromia in a patient with familial exudative vitreoretinopathy

Purpose: To report a case of 16-month-old boy with a novel variant TSPAN12 gene-presenting as unilateral myopia, pediatric cataract, and heterochromia in a patient with familial exudative vitreoretinopathy. Observation: A 16-month-old otherwise healthy boy was referred to Boston Children’s Hospital for evaluation of strabismus. Ocular examination revealed intermittent esotropia, left hypotropia, and limited left eye elevation in both adduction and abduction. Full cycloplegic hyperopic correction of +3.50 diopters (D) over both eyes was given to the patient. Over several months, refraction of the right eye showed progressive myopia (−6.00 D) with new onset iris heterochromia. Fundus examination showed there was a large area of chorioretinal atrophy with abrupt ending of the blood vessels; anterior to the ora serrata there were diffuse vitreous bands and veils that reached the lens anteriorly in direct contact with the lenticular opacity. A novel heterozygous nonsense likely pathogenic variant was identified in the TSPAN12 gene (NM_012338.3) c.315T>A (p.Cys105Ter) confirming the diagnosis of FEVR. Conclusion and importance: Asymmetric FEVR rarely present with unilateral axial myopia however association with acquired heterochromia and cataract has never been reported. We report a case of FEVR caused by a novel TSPAN12 likely pathogenic nonsense variant presenting as unilateral progressive myopia, acquired heterochromia, and pediatric cataract.

Intraocular epidermal growth factor concentration, axial length, and high axial myopia

Purpose Various molecules such as dopamine have been found to be associated with axial elongation in experimental studies. Here, we examined whether intraocular EGF is associated with axial length in myopic patients. Methods The hospital-based investigation included patients of European descent without optic nerve, retinal, or macular diseases except for myopic maculopathy. Using aqueous humor samples collected during surgery, the EGF concentration was examined applying a cytometric bead array. High myopia was defined by an axial length of ≥ 27.0 mm. Results The study included a non-highly myopic group of 11 patients (mean age, 72.9 ± 10.8 years; mean axial length, 24.3 ± 1.1 mm) and a highly myopic group of three patients (age, 81.11 ± 12.3 years; axial length, 29.5 ± 1.3 mm), with one of them having pathologic myopic maculopathy. In multivariable linear regression analysis, higher EGF concentration was correlated with the highly myopic versus non-highly myopic group (beta, 1.24; non-standardized correlation coefficient B, 6.24; 95% confidence interval (CI), 0.10,12.4;P = 0.047) after adjusting for axial length. The amount of intraocular EGF was significantly higher in the highly myopic group than in the non-highly myopic group (89.1 ± 40.8 pg versus 34.1 ± 13.2 pg; P = 0.005), and it was highest in the eye with myopic maculopathy (135 pg). Conclusions The intraocular amount of EGF is higher in highly myopic versus non-highly myopic eyes.