The Morphologic Classification Of Myopic Maculopathy And Influence Factors

OBJECTIVE:To observe the characteristics of fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) in clinically significant myopic maculopathy. Classify the features, and analyze the correlation between FFA and OCT classification and their influencing factors.METHODS:A total of101eyes from61patients with clinically significant myopic maculopathy,who visited Lanzhou University Second Hospital outpatient departmentand inpatient department from June20,2013to August31,2013. Including52right eyes,49left eyes. Distant Vision was examined through E Standard Logarithm Eyesight Table. Integrated Optometry to determine the diopter and Best Corrected Visual Acuity (BCVA). Axial length (AL) measurements obtained through IOL-Master. Fundus examinations performed in patients high myopia after pupil dilation. Optical coherence tomography and fluorescein angiography were done separately in each case of myopic maculopathy on the same day. Indocyanine green angiography (ICGA) was done if need be. The correlation between FFA types and OCT types were analyzed, and their associations with myopic refraction, BCVA, axial length and central foveal thickness were evaluated.RESULTS:1. The FFA and OCT classification of myopic maculopathyFFA Classification:Lacquer cracks, CNV and macular atrophy. Macular atrophy is divided into three subtypes:diffuse chorioretinal atrophy, patchy chorioretinal atrophy and large geographic areas of deep chorioretinal atrophy.OCT Classification:According to the variations of shape and structure of macular, it is divided into three types. Type1or Type2is divided into A and B two subtypes respectively by with or without MTM/CNV.2.The correlation of OCT and FFA classifications in myopic maculopathy and influence factorsThe prevalence of lacquer crack was higher in the OCT type1(57.14%) than in the CNV and macular atrophy (both21.43%, P<0.05) of fluorescein angiography.The prevalence of macular atrophy type was higher in the OCT type2(67.80%) than in the lacquer crack (18.64%, P<0.05) and CNV (13.56%, P<0.05).The macular atrophy type all belonged to the OCT Type3,but Type3did not all belong to the macular atrophy type. FFAAge:Patients with lacquer cracks were obviously younger than those with CNV, patchy chorioretinal atrophy and large geographic areas of deep atrophy (P<0.05). Three kinds of macular atrophy had no obvious difference between each other.Myopic Refraction:The eyes with lacquer cracks were significantly less myopic than those with CNV, diffuse atrophy, patchy atrophy and large geographic areas of deep chorioretinal atrophy patients(P<0.05). The eyes with CNV were significantly less myopic than those with the large geographic areas of deep atrophy (P<0.05).AL:The axial length of eyes with lacquer cracks was significantly shorter than the patchy chorioretinal atrophy and the large geographic areas of deep atrophy (P<0.05).The axial length of eyes with CNV was significantly shorter than the large geographic areas of deep atrophy (P<0.05).BCVA:The BCVA of eyes with lacquer cracks was obviously higher than those with CNV and the large geographic areas of deep atrophy (P<0.05).The BCVA of eyes with CNV was obviously lower than those with three kinds of macular atrophy (P<0.05).The eyes with diffuse atrophy had obviously better BCVA than the large geographic areas of deep atrophy (P<0.05).Central Foveal Thickness:The central foveal thickness of eyes with lacquer cracks was significantly thicker than those with large geographic areas of deep atrophy.(P<0.05),but three kinds of macular atrophy had no obvious difference between each other.OCTAge:There was no obvious difference between the age of patients in Type1A and those in Type1B, but the patients in Type1A were significantly younger than those in Type2B and Type3(P<0.05). The patients in Type2B or Type3were significantly older than other groups (P<0.05), but they had no obvious difference between each other.Myopic Refraction:The patients in Type1A had significantly less myopic refraction than Type2A,2B and3(P<0.05), but there was no obvious difference between Type1A and1B. The myopic refraction of eyes in Type1B was significantly lower than Type2A (P<0.05), there was no obvious difference between Type2A,2B and3.AL:There was no obvious difference between the AL of eyes in Type1A and1B, but the eyes in both Type1A and1B had significantly shorter AL than those in Type2A,2B and3(P<0.05).Type2A had significantly longer AL than Type2B (P<0.05).BCVA:There was no obvious difference between the BCVA of patients in Type1A and1B.The eyes in Type1A or1B had significantly better BCVA than those in Type2B and3(P<0.05), but it had no obvious difference between each other.There was no obvious difference between the Type2B and3, but the BCVA of eyes in Type3was significantly lower than the other groups (P<0.05). Central Foveal Thickness:There was no obvious difference between the central foveal thickness of eyes in Type1A and2A.The central foveal retinal thickness of eyes in Type3was the thinnest, it had significantly thinner central foveal retinal thickness than Type0,1A and2A (P<0.05).CONCLUSION:The atrophy and structure disturbance of macular retina and choroid aggravated gradually, with the increasing of age, myopic refraction and axis length of patients, so the morphological types of myopic maculopathy were different. There was a significant correlation between the features of FFA and OCT in myopic maculopathy. The analysis of clinically significant myopic maculopathy based on the integration of OCT and FFA features will be helpful to realize the development and severity of disease, it will prove to be one of strong supports for a more scientific, reasonable and effective therapeutic schedule.