The Journal of Retina and Vitreous Diseases

DIFFUSE CHORIORETINAL ATROPHY IN CHINESE HIGH MYOPIA The ZOC-BHVI High Myopia Cohort Study

Liu, Ran MD; Guo, Xinxing MD, Xiao, Ou MD, PhD; Li, Zhixi MD, PhD; Zhang, Jian MS; Lee, Jonathan Tak Loong MBBS; Wang, Decai MD, PhD; Sankaridurg, Padmaja PhD; Jong, Monica PhD, BOptom; He, Mingguang MD, PhD,

Retina: February 2020 – Volume 40 – Issue 2 – p 241-248

Purpose:

To explore the associations between diffuse chorioretinal atrophy (DCA) and age, sex, axial length, spherical equivalent, and best-corrected visual acuity (BCVA) among highly myopic eyes.

Methods:

This study included right eyes of 857 bilaterally highly myopic individuals from the ZOC-BHVI Cohort Study. Participants underwent examinations, including BCVA, ocular biometry, autorefraction, and color fundus photography. An Early Treatment Diabetic Retinopathy Study grid was applied on the fundus photographs to evaluate the location of DCA, which was graded into four categories (D0–D3). The characteristics and ocular biometry were compared between participants’ eyes with and without DCA.

Results:

Diffuse chorioretinal atrophy was found in 177 (20.6%) eyes. The proportion of participants with DCA in age groups of 7 to 11, 12 to 18, 19 to 39, and ≥ 40 years old was 20.9%, 9.2%, 23.1%, and 52.9%, respectively. The proportion of DCA significantly increased with longer axial length and worse myopic spherical equivalent. Eyes with DCA had poorer BCVA (Snellen visual acuity 20/36, logarithm of minimal angle of resolution 0.26 ± 0.25) than those without DCA (Snellen visual acuity 20/23, logarithm of minimal angle of resolution 0.06 ± 0.14) (P < 0.001). The BCVA gradually declined as the lesion got closer to the fovea (Pfor trend < 0.001).

Conclusion:

The proportion of DCA increased with older age, longer axial length, and more myopic spherical equivalent. Diffuse chorioretinal atrophy is a vision-threatening complication of high myopia where BCVA gradually worsens with foveal involvement.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FEATURES OF SUBRETINAL FIBROSIS AFTER MYOPIC NEOVASCULARIZATION

Milani, Paolo MD; Pellegrini, Marco MD; Massacesi, Amedeo MD; Scotti, Fabrizio MD; Moschini, Stefania MD; Setaccioli, Marco MD; Secondi, Roberta MD; Bergamini, Fulvio MD

Abstract

Purpose:

To describe the optical coherence tomography (OCT) angiography features of subretinal fibrosis in eyes with myopic choroidal neovascularization after natural evolution or secondary to intravitreal anti–vascular endothelial growth factor therapy.

Methods:

Retrospective observational case series. All eyes underwent a multimodal imaging examination including fluorescein angiography, spectral domain OCT, OCT angiography, and en face OCT.

Results:

Twenty-five eyes of 25 patients with mean age of 56.4 ± 14.9 were included in the study. Subretinal fibrosis was diagnosed at mean 30 (range 6–116) months before inclusion. Within the subretinal fibrosis, an abnormal vascular network was observed in 20/25 (80%) eyes, located typically in the outer retina (18/20, 90%) or the choriocapillaris (14/20, 70%) segmentation. The most prevalent patterns were “round tangle” and “tapered tangle.” On en face OCT, the subretinal fibrosis was evidenced in 24/25 (96%) eyes, most prevalently in the outer retina (21/25, 84%) and in the choriocapillaris (18/25, 72%), where main feature was white-hyperreflective (20/21, 95%) and dark-hyporeflective (17/18, 94%) appearance, respectively. The presence of subretinal fibrosis on en face OCT was positively correlated with the presence of abnormal vascular network on OCT angiography in 61% of the cases (P = 0.005).

Conclusion:

Subretinal fibrosis secondary to myopic choroidal neovascularization frequently contains blood flow within a persistent abnormal vascular network as assessed by OCT angiography.

MACULAR ATROPHY IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION A Pilot Post Hoc Analysis of Patients With Pigment Epithelial Detachments

Rebhun, Carl B. MD; Moreira-Neto, Carlos MD, PhD; Gune, Shamika MD; Hill, Lauren MS; Duker, Jay S. MD; Waheed, Nadia K. MD, MPH

Retina: February 2020 – Volume 40 – Issue 2 – p 266-272

Abstract

Purpose:

To determine optical coherence tomography signs associated with macular atrophy (MA) in eyes with neovascular age-related macular degeneration and pigment epithelial detachments treated with vascular endothelial growth factor inhibitors.

Methods:

Optical coherence tomography scans from a subgroup of the pigment epithelial detachment cohort of the HARBOR study were analyzed for MA. Two groups were formed based on MA presence/absence at Month 24. Then, optical coherence tomography scans from each baseline visit were graded with standard reading center grading parameters including ellipsoid zone disruption, intraretinal cysts, subretinal fluid, and MA or nascent MA in the study and fellow eyes.

Results:

Twenty-eight eyes from 28 patients were included in the analysis. Fourteen eyes had optical coherence tomography–based MA at Month 24 and 14 did not. Macular atrophy at Month 24 was significantly associated with 1) MA/nascent MA at baseline (P = 0.0136), 2) intraretinal cysts at baseline (P = 0.0048), and 3) collapse of pigment epithelial detachments in the study eye (P = 0.0025). Macular atrophy was not associated with ellipsoid zone disruption or subretinal fluid in the study eye at baseline.

Conclusion:

This study suggests that some optical coherence tomography findings in eyes of patients with neovascular age-related macular degeneration were present before the start of anti–vascular endothelial growth factor therapy and may predict the development of MA.