Optical coherence tomography angiography in the diagnosis of myopic choroidal neovascularization

Close metadata

MATERIAL AND METHODS

The study examined 48 patients (40 females, 8 males) aged 18 to 54 years with pathological myopia complicated by SNM. All patients underwent standard ophthalmological examination including optical coherence tomography (OCT).

RESULTS

Myopic SNM was detected in 56 eyes of 48 examined PM patients (the process was bilateral in eight patients). A pronounced increase in the axial eye length was accompanied by extreme thinning of the choroid, dystrophic changes in the posterior pole, and decreased visual acuity. In 20% of cases (11 eyes), the disease was detected during its active phase, in 37.5% (21 eyes) — scarring stage, in 43% (27 eyes) — atrophy stage. The blood flow inside the membranes was recordable at all stages of the pathological process. Perforating intrascleral vessels that communicate with neovascular membranes could be seen in all patients. The filling-up of these vessels with contrast in the early arterial phase of fluorescein angiography (FA) suggests that they are the branches of the short posterior ciliary arteries (SPCA).

CONCLUSION

The key link in the pathogenesis of myopic SNM is pathological arteriogenesis, in which the branches of the SPCA are the source of the formation of neovascular membranes.

Keywords:

myopic choroidal neovascularization

optical coherence tomography angiography

pathological myopia

Authors:

Zhukova S.I.

Irkutsk Branch of S.N. Fyodorov National Medical Research Center «MNTK «Eye Microsurgery»

Received:

05.03.2021

Accepted:

19.04.2021

List of references:

Brien A, Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-1042. https://doi.org/10.1016/j.ophtha.2016.01.006
Ohno-Matsui K, Yoshida T, Futagami S, et al. Patchy atrophy and lacquer cracks predispose to the development of choroidal neovascularization in pathological myopia. Brit J Ophthalmol. 2003;87:570-573. https://doi.org/10.1136/bjo.87.5.570
Avetisov E. Blizorukost [Myopia]. M.: Medicine; 1999. (In Russ.).
Libman YeS, Shakhova YeV. Blindness and disability due to visual organ pathology in Russia. Vestnil oftal’mologii. 2006;(1):35-37. (In Russ.).
Lai TY, Cheung CM. Myopic choroidal neovascularization: diagnosis and treatment. Retina. 2016;36(9):1614-1635. https://doi.org/10.1097/IAE.0000000000001227
Fang Y, Yokoi T, Nagaoka N, et al. Progression of myopic maculopathy during 18-year follow-up. Ophthalmology. 2018;125(6):863-877. https://doi.org/10.1016/j.ophtha.2017.12.005
Hayashi K, Ohno-Matsui K, Shimada N, et al. Long-term pattern of progression of myopic maculopathy: a natural history study. Ophthalmology. 2010;117(8):1595-2206. https://doi.org/10.1016/j.ophtha.2009.11.003
Wong YL, Saw SM. Epidemiology of pathologic myopia in Asia and worldwide. Asia Pac J Ophthalmol. 2016;5(6):394-402. https://doi.org/10.1097/APO.0000000000000234
Moriyama M, Ohno-Matsui K, Futagami S, et al. Morphology and long-term changes of choroidal vascular structure in highly myopic eyes with and without posterior staphyloma. Ophthalmology. 2007;114(9):1755-1762. https://doi.org/10.1016/j.ophtha.2006.11.034
Neelam K, Cheung CM, Ohno-Matsui K, et al. Choroidal neovascularization in pathological myopia. Prog Retin Eye Res. 2012;31(5):495-525. https://doi.org/10.1016/j.preteyeres.2012.04.001
Gao LQ, Liu W, Liang YB, et al. Prevalence and characteristics of myopic retinopathy in a rural Chinese adult population: the Handan Eye Study. Arch Ophthalmol. 2011;129(9):1199-1403. https://doi.org/10.1001/archophthalmol.2011.230
Zheng Y, Lavanya R, Wu R, et al. Prevalence and causes of visual impairment and blindness in an urban Indian population: the Singapore Indian Eye Study. Ophthalmology. 2011;118(9):1798-1804. https://doi.org/10.1016/j.ophtha.2011.02.014
Schuko AG, Zatseva NV, Iureva TN, et al. The influence of immunological factors on the formation mechanisms of myopic choroidal neovascularization. Vestnil oftal’mologii. 2016;132(5):5-14 (In Russ.). https://doi.org/10.17116/oftalma201613255-14
Grigorieva AV, Iureva TN, Kursakova YuV, Ivanova YeI. The role of changes in hormonal status in the formation of myopic chorioretinal neovascularization. Sovremenniye tekhnologii v oftalmologii. 2017;4:61-64 (In Russ.).
Spaide RF, Ohno-Matsui K, Yannuzzi LA. Pathologic Myopia. New York: Springer-Verlag; 2014;360.
Ohno-Matsui K, Jonas JB, Spaide RF. Macular Bruch membrane holes in choroidal neovascularization-related myopic macular atrophy by swept-source optical coherence tomography. Am J Ophthalmol. 2016;162:133-139. https://doi.org/10.1016/j.ajo.2015.11.014
Querques G, Corvi F, Balaratnasingam C, et al. Lacquer Cracks and Perforating Scleral Vessels in Pathologic Myopia: A Possible Causal Relationship. Am J Ophthalmol. 2015;160(4):759-766-e2.
Louzada RN, Ferrara D, Novais EA, et al. Analysis of scleral feeder vessel in myopic choroidal neovascularization using optical coherence tomography angiography. Ophthalmic Surg Lasers Imaging Retina. 2016;47: 960-964.
Giuffré C, Querques L, Carnevali A, et al. Choroidal neovascularization and coincident perforating scleral vessels in pathologic myopia. Eur J Ophthalmol. 2017;27:39-45. https://doi.org/10.5301/ejo.5000875
Schouten IM, Palkar AH, Bhende M. Macular vortex vein with choroidal neovascularization in pathologic myopia. Indian J Ophthalmol. 2019;67(10): 1717-1718. https://doi.org/10.4103/ijo.IJO_130_19
Ishida T, Watanabe T, Yokoi T, et al. Possible connection of short posterior ciliary arteries to choroidal neovascularisations in eyes with pathologic myopia. Brit J Ophthalmol. 2019;103:457-462. https://doi.org/10.1136/bjophthalmol-2018-312015
Novitskiy VV, Goldberg ED, Urazova OI. Patifiziologia. Uchebnik v 2 t. Pod red. M.: Izdatel’stvo GEOTAR-Media; 2009. (In Russ).

Close metadata