| Myopic maculopathy is a common fundus feature of pathological myopia,including retinal pigment epithelium(RPE)and choroidal capillary layer Atlas atrophy,vitreous membrane(Bruch’s membrane)rupture(lacquer crack),submacular choroidal neovascularization,RPE and subepithelial hemorrhage,Fuchs spots,mopic foveoschisis,macular hole and anterior macular membrane formation.The definition and classification of myopic maculopathy are still controversial in the world.Myopic maculopathy can cause irreversible visual impairment in most cases.With an increasing number of people suffering from pathological myopia in East Asian year by year,the incidence of myopic macular lesions also increases.Myopic maculopathy develops rapidly in the eyes with tessellated fundus,and what’s more,it’s difficult to be treated and controlled all over the world.Posterior scleral reinforcement is an effective surgical method for the treatment of pathological myopia,and its effect on delaying the progress of high myopia has been accepted by more and more people.However,as the classification and grading of myopic macular lesions have no clear conclusion,intuitive result hasn’t been obtained at present about the control effect of scleral reinforcement on the progression of myopic maculopathy.Recently,Jorge Ruiz-Medrano proposed a new ATN grading system,which makes it concise and convenient to observe the progression of myopic maculopathy after posterior scleral reinforcement and to compare the effects before and after surgery.Objective:To investigate the effect of posterior scleral reinforcement on myopic maculopathy by observing the changes of ATN grading,diopter,eye axis length,best corrected visual acuity,visual field and subfoveal choroidal thickness after posterior scleral reinforcement.MethodsWe did retrospective analysis of patients with myopic maculopathy diagnosed in our hospital from January 2014 to January 2016 who underwent posterior scleral reinforcement in one eye alone,selected the cases in which the information was complete,92 cases(92 eyes)were eligible.In these cases,Posterior scleral reinforcement was performed in one eye,glasses or RGP were selected on the fellow eyes,there were 37 males and 55 females among them aged from 18 to 68.The clinical effects were observed at 3 months,6 months,1 year or more after operation.After the first year,the patients were followed up once a year.The last follow-up time ranged from 2 to 5 years.The follow-up period was at least 2 years,with an average follow-up time of 3.42±0.87 years.These cases are graded by the ATN grading system according to the results of fundus photography and OCT before operation,FFA+ICGA was performed if necessary.The preoperative diopter,axial length,best corrected visual acuity,visual field and subfoveal choroidal thickness were(-17.07±4.21)D,(30.24±1.69)mm,0.52(0.60)logMAR,(-12.37±5.56)dB,(58.11±37.04)μm,respectively.Contralateral diopter,axial length,best corrected visual acuity,visual field and subfoveal choroidal thickness were(-16.98±3.86)D,(30.21±1.65)mm,0.52(0.52)logMAR,(-11.92±4.90)dB,(59.86±32.94)μm,respectively.The changes of ATN grading,diopter,axial length,best corrected visual acuity,visual field and subfoveal choroidal thickness were observed at the last follow-up time,and the effect of surgery was evaluated.The progress pattern of myopic macular disease and the mechanism of posterior scleral reinforcement were studied.Statistical analysis methodSPSS21.0 statistical software was used for data analysis.Kolmogorov-Smirnov normal distribution test was used for each group of measurement data.Matched t-test was used for the normal distribution,and the experimental data were expressed as((?)±s).If it does not conform to normal distribution,the paired sign rank sum test is used,and the experimental data are expressed by M(QR).Count data were compared byχ~2.P<0.05 was considered to be statistically significant.Results1.Diopter(spherical equivalent)changesOperative eyes:At the last follow-up,there was no significant difference in diopter(-17.26±3.99)D and preoperative(-17.07±4.21)D(t=1.224,P=0.224).Fellow eyes:At the last follow-up,the diopter(-18.96±3.93)D was significantly different from preoperative(-16.98±3.86)D(t=17.983,P=0.000).The diopter of this group is still in progression.2.The axial length changesOperative eyes:At the last follow-up,there was a significant difference in axial length(30.42±1.72)mm compared with preoperative(30.24±1.69)mm(t=-6.400,P=0.000).The axial length after operation was prolonged(0.18±0.26)mm compared with that before operation.Fellow eyes:At the last follow-up,there was a significant difference in axial length(31.00±1.74)mm compared with preoperative(30.21±1.65)mm(t=-17.378,P=0.000).In this group,the length of eye axis was prolonged(0.79±0.41)mm compared with that before operation,and the difference was significant(t=11.694,P=0.000)compared with the progress of operation(0.18±0.26)mm.3.Best corrected visual acuity changesOperative eyes:There was no significant difference in logMAR between the best corrected visual acuity 0.60(0.60)and the preoperative 0.52(0.60)at the last follow-up(Z=-1.808,P=0.071).Fellow eyes:The best corrected visual acuity at the last follow-up was 0.70(0.48)logMAR and 0.52(0.52)logMAR before operation.The difference between them was significant(Z=-4.207,P=0.000).The best corrected visual acuity continued to decline in this group.4.Visual filed changes(MD)Operative eyes:There was no significant difference in visual field between the last follow-up(-12.94±5.29)dB and preoperative(-12.37±5.56)dB(t=1.236,P=0.221).Fellow eyes:The last follow-up visual field(-13.39±4.63)dB was significantly different from that of preoperative(-11.92±4.90)dB(t=4.607,P=0.000).Visual field defect was increased in this group.5.Subfoveal choroidal thicknessOperative eyes:At the last follow-up,the subfoveal choroidal thickness(55.95±36.61)μm decreased compared with preoperative(58.11±37.04)μm,but there was no significant difference(t=1.892,P=0.064).Fellow eyes:At the last follow-up,the subfoveal choroidal thickness(48.31±28.13)μmwas significantly different from that before surgery(59.86±32.94)μm(t=6.786,P=0.000).Subfoveal choroidal thickness was decreased in this group.6.ATN grading changeAtrophic myopic maculopathy(A)Operative eyes:There are 64 eyes in A2(diffuse chorioretinal atrophy)stage with 14 eyes in progression.Among them 12 eyes showed enlarged atrophy and two eyes progressed to A3(patchy chorioretinal atrophy).Eight of 19 eyes in stage A3showed patchy atrophy,enlargement or fusion.In A4 stage,macular atrophy in one eye showed enlarged macular atrophy.Fellow eyes:With 68 eyes in A2(diffuse chorioretinal atrophy)stage,the fundus characteristics were progressive in 35 eyes,of which 26 eyes showed enlarged atrophy range.Nine eyes progressed to A3(patchy chorioretinal atrophy),while 33eyes did not.With 17 eyes in A3(patchy chorioretinal atrophy)stage,11 eyes showed progression,of which 10 eyes showed enlargement or fusion of macular atrophy,1eye progressed to A4(macular atrophy),and 6 eyes showed no significant progress.In A4(macular atrophy)stage,macular atrophy was enlarged in 2 eyes of 7.The progressive rate of atrophic myopic macular lesion(A)was 25.00%,which was significantly lower than 52.17%in the contralateral eye(χ~2=15.394,P=0.000).Tractional myopic maculopathy(T):Operative eyes:Of 44 eyes with myopic foveoschisis(T1~T3),2 eyes showed enlargement of myopic foveoschisis cavity,1 eye progressed to T5(macular hole+retinal detachment),32 eyes showed disappearance of myopic foveoschisis cavity,T0(no myopic foveoschisis)and 9 eyes showed decrease of myopic foveoschisis cavity.Contralateral eye:Four eyes of 56 T0 eyes developed new myopic foveoschisis,three eyes developed from T3(full-thickness macular myopic foveoschisis)to T5(macular hole and retinal detachment),and nine eyes showed enlargement of myopic foveoschisis cavity.The progressive rate of tractive myopic macular lesion(T)was 3.26%,which was significantly lower than that of the contralateral eye 17.39%(χ~2=10.889,P=0.001)Neovascular myopic macular lesions(N).Operative eyes:Two eyes showed new lacquer cracks(N1)after operation,and one eye developed myopic CNV(N2a)with lacquer cracks(N1)before operation.Cracks of 2 eye paints increased or widened.Contralateral eye:Five of 64 N0(non-myopic CNV)eyes showed new lacquer cracks,which progressed from N0 to N1,and two of them developed into myopic CNV(N2a).Six eyes of 15 N1 eyes showed increased or widened lacquer cracks,and two eyes developed to myopic CNV(N2a).The progressive rate of neovascular myopic macular lesion(N)in surgical eyes was 5.43%lower than 16.30%in contralateral eyes(χ~2=6.438,P=0.011).Conclusions1.Posterior scleral reinforcement is an effective method to control the progression of myopic maculopathy.2.Posterior scleral reinforcement is effective in stabilizing the visual field and choroidal thickness of myopic maculopathy. |
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