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AIM: To evaluate the global trends in and explore hotspots of high myopia (HM) research. METHODS: This bibliometric analysis was used to reveal the publication trends in HM research field based on the Web of Science Core Collection (WoSCC). VOSviewer version 1.6.13 software was used to analyze the data and construct a knowledge map including the yearly publication number, journals, countries, international collaborations, authors, research hotspots, and intellectual base in HM. RESULTS: The search engine found 3544 peer-reviewed publications on HM between 2010 and 2019, and the yearly research output substantially elevated over the past decade. China is the top publishing country, and Sun Yat-sen University was the most active academic institution. Jonas JB is the top publishing scientist, and Investigative Ophthalmology and Visual Science (IOVS) was the most productive journal. The highest cited references mainly focused on epidemiology and management. The keywords formed 6 clusters: 1) refractive surgery; 2) etiology and clinical characteristics; 3) the mechanism of eye growth; 4) management for myopic maculopathy; 5) vitrectomy surgical treatment; 6) myopia-associated glaucoma-like optic neuropathy. CONCLUSION: The evaluation of development trends based on the data extracted from WoSCC can provide valuable information and guidance for ophthalmologists and public health researchers to improve management procedures in HM field.

To evaluate the prevalence and visual outcomes of macular Bruch membrane (BM) defects in patients treated with anti-vascular endothelial growth factors (VEGF) for choroidal neovascularization secondary to pathological myopia (mCNV). Single-center retrospective observational case series of 68 eyes from 62 patients with mCNV treated with one anti-VEGF injection followed by a pro re nata (1 + PRN) regimen. A minimum follow-up of 6 months was defined. Chorioretinal atrophy was assessed by fundus examination, fluorescein angiography, and SD-OCT. Median follow-up was 28.5 (range 6–89) months with a median number of 5 anti-VEGF injections. At baseline, 27.9% of eyes had macular BM defects increasing to 36.8% during follow-up (p

Purpose: to determine the features of myopic choroidal neovascularization (mCNV) using optical coherent tomography-angiography (OCTA) in patients with complicated myopia during anti-VEGF therapy.Patients and methods. A prospective study of 25 people (40 eyes) with complicated myopia was carried out, which consisted in a comparative analysis of the qualitative and quantitative OCTA characteristics of 29 eyes with myopic CNV and 11 paired intact eyes. OCTA was used in the Angio Retina and Angio Analytics modes based on automatic software. The phenotypic features of CNV before treatment, during anti-VEGF therapy (Ranibizumab) and at the end of the observation period were taken into account.Results. The average follow-up period is 26.12 (12.36; 35.02) months. Two mCNV phenotypes were established: glomerular (44.83 %) and flat (55.17 %) as regularized (18.75 %) and tangled (81.25 %) vascular network patterns. Hypointensive peripheral halo during the entire period of the neovascular complex activity was visualized regardless of the phenotype. Significant differences in the flat phenotype were revealed: neuroepithelial detachment (87.50 %) was more common, the Select Area and Flow Area of the neovascular complex was significantly greater both before treatment and at the end of the observation period, the mCNV course of continued growth after injection of anti-VEGF did not occur, recurrence rate is much higher. The area and perimeter of the foveal avascular zone (FAZ) in the eyes with mCNV increased significantly by the end of the observation. The acirculatory index (AI) was determined to be significantly higher, and the Retinal capillary flow density in the fovea region 300 μm wide around the FAZ (FD) was lower in the eyes with mCNV compared to the control group. The nonactive neovascular complex were characterized by depletion of the vascular network with a predominance of intervascular space, vessels in the form of a residual skeleton, blindly end, dim, small capillaries and end loops are missing. Halo with nonactive CNV is not found.Conclusion. OCTA identifies the features of the course of myopic CNV depending on the phenotype, allows to evaluate the effectiveness of anti-VEGF therapy and the degree of progression of degenerative changes in the macular region.

Aim: The aim of this study was to evaluate and compare the 24-month follow-up results of intravitreal conbercept with ranibizumab in the treatment of choroidal neovascularization (CNV), secondary t...

Introduction: Pathological myopia is commonly associated with myopic traction maculopathy, which includes foveoschisis, foveal retinal detachment, macular hole (MH) and/or macular detachment (MD). Macular buckling is a rarely practiced extraocular surgical modality these days. The purpose of this study was to investigate the efficacy of primary buckling with Morin–Devin T implant for MD with MH and posterior staphyloma. Case description: A 52-year-old female presented with light perception vision in her right eye with posterior staphyloma, localized neurosensory detachment, and MH. She underwent primary macular buckling with Morin–Devin T implant. During the immediate postoperative day the wedge indentation was found misaligned to the fovea. A revision surgery was done after 2 weeks for repositioning of the macular wedge. Spectral domain optical coherence tomography confirmed indentation at the MH with resolution of subretinal fluid and hole closure. Her BCVA was 2/60 at 3 months postoperative and it remained the same even at 6 months of follow-up. Conclusions: Primary macular buckling can be an effective procedure in eyes with MH with detachment and posterior staphyloma with or without associated foveoschisis. Morin–Devin T implant placement is a relatively simple procedure with short surgical time and excellent outcome.

A computer-aided diagnostic tool for myopia detection is of paramount importance since the pathology results in irreversible damage to the eye. Unfortunately, designing of such systems is hindered by several issues such as (i) difficulties in segmentation of optic disc (OD) due to smooth variability between the OD and other retinal features, (ii) greater degree of correlation between myopia and non-myopic features, and (iii) lack of feasibility for adopting in a clinical setting. The proposed methodology is designed to address the aforementioned issues. First, blood vessels are detected and excluded. Second, the optic disc region is segmented using deformable models. Further, two classification set-ups are tested to determine the rate of accurate classification to detect myopia. Quantitative analysis is performed on the PALM dataset achieving, sensitivity, specificity, and accuracy of 90.3 %, 100 %, and 95 % respectively.

Aim This study aimed to compare macular findings between low and high myopia. Patients and methods In all, 60 myopic eyes were included in this study. They were divided according to refraction into low myopia of less than or equal −6 SD and high myopia of more than −6 SD. All patients were subjected to automated refraction, correction of vision, A-scan by Isa intra Ocular length (IOL) master for axial length, and optical coherence tomography (OCT) scan for macular mapping. Results The mean central macular thickness (CMT) of low myopic cases was 255.5±17.13, with all low myopic cases showing no complication by OCT while the mean CMT of high myopia was 262.10±67.51 with some complications. Regarding choroidal neovascularization (CNV), it was statistically significantly higher in the high myopic group when compared with the low myopic group, while macular hole showed no significance. Thinning of RPE and myopic contour showed high significant statistical difference to high myopic group. Discussion The mean CMT of low myopic cases was slightly thinner than in high myopic cases but with no statistical significance. Myopic CNV is more common with high myopia and may be related to sex. Thinning of RPE and myopic contour are mainly found in high myopia. Conclusions In our study, there was no significant correlation between CMT and axial length. Regarding CNV, it was statistically significantly higher in the high myopic group when compared with the low myopic group, while macular hole showed no significance. Thinning of RPE and myopic contour are mainly found in high myopia.

Background RP (retinitis pigmentosa) is a group of hereditary retinal degenerative diseases. XLRP is a relatively severe subtype of RP. Thus, it is necessary to identify genes and mutations in patients who present with X-linked retinitis pigmentosa. Methods Genomic DNA was extracted from peripheral blood. The coding regions and intron-exon boundaries of the retinitis pigmentosa GTPase regulator (RPGR) and RP2 genes were amplified by PCR and then sequenced directly. Ophthalmic examinations were performed to identify affected individuals from two families and to characterize the phenotype of the disease. Results Mutation screening demonstrated two novel nonsense mutations (c.1541C > G; p.S514X and c.2833G > T; p.E945X) in the RPGR gene. The clinical manifestation of family 1 with mutations in exon 13 was mild. Genotype-phenotype correlation analysis suggested that patients with mutations close to the downstream region of ORF15 in family 2 manifested an early loss of cone function. Family 2 carried a nonsense mutation in ORF15 that appeared to have a semi-dominant pattern of inheritance. All male patients and two female carriers in family 2 manifested pathological myopia (PM), indicating that there may be a distinctive X-linked genotype-phenotype correlation between RP and PM. Conclusions We identified two novel mutations of the RPGR gene, which broadens the spectrum of RPGR mutations and the phenotypic spectrum of the disease in Chinese families.

To determine the incidence and characteristics of intrachoroidal cavitation (ICC) in the eyes with high myopia. In this retrospective, non-interventional, comparative study, we analysed the case records of 108 eyes with and without pathological myopia (PM). PM was defined as having a refractive error (spherical equivalent) of ≥ − 6.0 D or axial length ≥ 26 mm. The presence of other features like posterior vitreous detachment, myopic traction maculopathy, posterior staphyloma, focal/patchy chorioretinal atrophy (CRA), choroidal neovascularisation and retinoschisis was looked for on OCT. The association of these features with ICC was analysed using statistical tests. In this study, 38 out of 68 eyes with PM and 4 out of 40 eyes with non-PM showed the bowing of the posterior sclera and the presence of ICC. On statistical analysis with Chi-square test and multiple variable linear regression analysis tests, it was identified that the presence of focal/patchy CRA (p = 0.005) and intrascleral vessels (p = 0.018) in and around the cavitation was important features noted in eyes with ICC. The OCT features of macular and peripapillary ICC were similar. The transudation of fluid from the dilated intrascleral vessels in and around the ICC could be one other mechanism responsible for the development of ICC. ICC is seen in 55.8% of highly myopic eyes with the presence of focal CRA or myopic conus and/or presence of intrascleral vessels near the cavitation. These findings suggest that patchy atrophy affects the scleral contour within posterior staphyloma beyond the funduscopically identified patchy atrophy by ICC. The presence of intrascleral vessels could also contribute to the ICC development. Eyes with patchy CRA or myopic conus needs to be checked on further follow-up visits for the development of macular or peripapillary ICC.

Purpose The purpose of this study was to investigate the relationship of posterior staphyloma (PS) types in pathological myopia (PM) with age, best-corrected visual acuity (BCVA), spherical equivalent (SE), axial length (AL), and myopic retinoschisis (MRS) using three-dimensional magnetic resonance imaging (3D-MRI) and optical coherence tomography (OCT). Methods This retrospective, cross-sectional study included 108 eyes of 59 patients with PM from the Henan Eye Institute, China. We classified the PS types based on current international classification criteria and analyzed the risk factors (age, AL, MRS, and BCVA). Results Most of the patients with bilateral PM had the same PS type (80.43%) in both eyes. Complex PS was more common in elderly patients than in younger patients (P < 0.05). Eyes with wide macular PS had a longer AL (P = 0.012) and worse BCVA (P = 0.049) than those with other PS types. MRS was always comorbid with PS (93.33%), and macular PS was the most common (82.14%). Conclusions Complex PS is associated with patient age. PS is related to MRS, and these changes observed by 3D-MRI and OCT affect the prognosis of visual acuity. The 3D-MRI scans shows changes in the eye shape and PS efficiently. Translational Relevance In patients with PM, 3D-MRI can guide the planning of posterior scleral reinforcement.

Background Insulin positively correlates with the length of the eye axis and is increased in the vitreous and serum of patients with pathological myopia (PM). How insulin influences the physiological process of retinal pigment epithelial (RPE) cells in PM remains unclear. This study aimed to explore the effect of insulin on the ultrastructure and function of RPE cells and the role of PI3K/AKT/mTOR signaling involved in the development of PM. Methods The ARPE-19 cells were treated with different concentrations of insulin to analyze the cell morphology, cell viability, the protein level of insulin receptor β, and the mRNA and protein levels of and PM-related factors (TIMP-2, MMP-2, bFGF, and IGF-1). The ultrastructure of APRE-19 cells was also observed after insulin treatment. Besides, the PI3K/AKT/mTOR signaling was studied with or without the PI3K inhibitor LY294002 in ARPE-19 cells. Results Insulin enhanced the cell viability of ARPE-19 cells and caused the endoplasmic reticulum to expand and vesiculate, suggesting increased secretion of growth factors and degeneration in ARPE-19 cells. Furthermore, the insulin receptor β was stimulated with insulin treatment, subsequently, the phosphorylation of AKT and mTOR was positively activated, which was adversely suppressed in the presence of LY294002. The secretion of TIMP-2 and bFGF was significantly decreased, and the secretion of MMP-2 and IGF-1 was highly elevated with insulin treatment depending on the concentration in ARPE-19 cells. Furthermore, the effect of insulin on PM-related proteins was restored with the addition of LY294002. Conclusions Our results indicated that insulin regulated the secretion of PM-related factors via the PI3K/AKT/mTOR signaling pathway in retinal pigment epithelial cells, and thus probably promoted the development of PM through transducing regulation signals from retina to choroid and sclera.

Purpose: To report the 24-month outcomes of vascular endothelial growth factor (VEGF) inhibitors for myopic choroidal neovascularization (mCNV) in predominantly Caucasian eyes in routine clinical practice. Methods: Retrospective analysis of treatment-na¿ıve eyes starting intravitreal injection of VEGF inhibitors of either bevacizumab (1.25 mg) or ranibizumab (0.5 mg) for mCNV from 1 January 2006 to 31 May 2018 that were tracked in the Fight Retinal Blindness! registry. Results: We identified 203 eyes (bevacizumab-85 and ranibizumab-118) of 189 patients. The estimated mean (95% CI) change in VA over 24 months for all eyes using longitudinal models was +8 (5, 11) letters with a median (Q1, Q3) of 3 (2, 5) injections given mostly during the first year. The estimated mean change in VA at 24 months was similar between bevacizumab and ranibizumab [+9 (5, 13) letters for bevacizumab versus +9 (6, 13) letters for ranibizumab; p = 0.37]. Both agents were also similar in the mCNV activity outcomes, treatment frequency and visit frequency. Conclusions: The 24-month treatment outcomes of VEGF inhibitors for mCNV were favourable in this largest series yet reported of predominantly Caucasian eyes in routine clinical practice,with approximately two lines of visual gain and amedian of three injections given mostly during the first year. These outcomes are similar to those reported for predominantly Asian eyes.Bevacizumab appeared to be as safeandeffective as ranibizumab. Key words: anti-VEGF therapy - Caucasian - high myopia - myopia - myopic choroidal neovascularization - optical coherence tomography - pathologic myopia - VEGF inhibitors

Devangna Bhatia, Alexander Mehta, Joanna DaCosta, Oonagh Crothers, James Stephen Talks Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UKCorrespondence: Devangna BhatiaNewcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UKEmail Devangna88@gmail.comAim: Evaluation of real-world outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in the primary treatment of choroidal neovascularization (CNV) secondary to pathological myopia.Patients and Methods: A retrospective cohort analysis of treatment naive patients with myopic CNV who received treatment with either intravitreal ranibizumab or aflibercept over a 12-year period from September 2007 to May 2020 was performed. Baseline features, treatment factors and outcomes were compared between younger and older patients and final visual outcome was assessed for associated factors.Results: Thirty-seven eyes of 36 patients (24 females, 12 males) were included. Mean age was 58 years (range=26– 89 years). Of these patients, 11/36 (31%) were ≤ 50 years of age and 25/36 (69%) were ≥ 51 years of age. Seventy-three percent (27/37) of eyes were phakic. One patient received bilateral treatment for myopic CNV. Median spherical equivalent was − 8.50 diopters. Seventy percent (26/37) of eyes commenced primary treatment with ranibizumab, and 11/37 (30%) eyes commenced treatment with aflibercept. There were no significant differences between treatment factors and outcomes of younger and older patients. Median number of injections was 3 over a median follow-up period of 24.6 months. Mean CRT decreased by 126μm and median visual improvement was +6 letters. Analysis showed that younger age (p=0.022) and fewer injections (p=0.004) were associated with better visual outcomes.Conclusion: Myopic CNV requires less frequent anti-VEGF intravitreal therapy over a shorter follow-up period than both neovascular age-related macular degeneration and diabetic macular edema. Increased frequency of administration of intravitreal anti-VEGF treatment did not improve vision. Younger age is associated with a better final visual outcome. These findings may help to advise patients about the prognosis of treatment and help guide treatment decisions.Keywords: myopia, pathological myopia, choroidal neovascularization, anti-VEGF intravitreal injection

This investigation reports on the results of convolutional neural networks developed for the recently introduced PathologicAL Myopia (PALM) dataset, which consists of 1200 fundus images. We propose a new Optic Nerve Head (ONH)-based prediction enhancement for the segmentation of atrophy and fovea. Models trained with 400 available training images achieved an AUC of 0.9867 for pathological myopia classification, and a Euclidean distance of 58.27 pixels on the fovea localization task, evaluated on a test set of 400 images. Dice and F1 metrics for semantic segmentation of lesions scored 0.9303 and 0.9869 on optic disc, 0.8001 and 0.9135 on retinal atrophy, and 0.8073 and 0.7059 on retinal detachment, respectively. Our work was acknowledged with an award in the context of the "PathologicAL Myopia detection from retinal images" challenge held during the IEEE International Symposium on Biomedical Imaging (April 2019). Considering that (pathological) myopia cases are often identified as false positives and negatives in classification systems for glaucoma, we envision that the current work could aid in future research to discriminate between glaucomatous and highly-myopic eyes, complemented by the localization and segmentation of landmarks such as fovea, optic disc and atrophy., Comment: 18 pages, 2 figures, preprint to journal

Myopia is a major health problem throughout the world due to its increasingly high prevalence in the past few decades. Myopia, in particular high myopia, is associated with a number of ocular complications such as glaucoma and cataract that are potentially blinding. Myopic macular degeneration, a major cause of visual impairment and blindness, affects 1–4% of the general populations in some countries. Increased amount of near-work activities and decreased time spent outdoors are the two most important environmental modifiable risk factors related to myopia onset and progression. Near-work activities including screen time with use of smartphones and devices might be a new major risk factor for myopia. Combining health behavior programs aiming to increase outdoor time and decreasing screen time may prevent the onset of myopia. Interventions to slow the progression of low myopia to high myopia may prevent severe disease and associated pathological myopia complications.

Purpose: To detect the vessel density (VD) of the radial peripapillary capillary (RPC) in eyes affected by pathological myopia with or without a peripapillary intrachoroidal cavitation (PICC) and in eyes with PICC complicated by choroidal neovascularization (CNV), using optical coherence tomography angiography (OCTA). Methods: We prospectively enrolled highly myopic patients from January 2016 to December 2019 at the Eye Clinic of the University of Naples “Federico II.” We divided included patients into three groups: group 1 including patients with PICC complicated by CNV; group 2 including patients with PICC without complications; group 3 including patients with high myopia without PICC and CNV. One-way analysis of variance (ANOVA) followed by Bonferroni post hoc analysis was used to evaluate differences in VD of radial peripapillary capillary (RPC) in papillary whole, peripapillary regions and its sectors among the three groups. Results: We enrolled 12 highly myopic eyes with PICC complicated by CNV, 21 highly myopic eyes with PICC without CNV and 23 highly myopic eyes without PICC. The myopic eyes with PICC revealed a statistically significant reduction in VD of the RPC comparing to the other groups ( p Conclusion: OCTA detects the changes in peripapillary vascular density of highly myopic eyes. We demonstrated that the RPC vasculature is significantly influenced by the presence of PICC, especially in myopic eyes developing a CNV.

The prevalence of myopia is increasing extensively worldwide. The number of people with myopia in 2020 is predicted to be 2.6 billion globally, which is expected to rise up to 4.9 billion by 2050, unless preventive actions and interventions are taken. The number of individuals with high myopia is also increasing substantially and pathological myopia is predicted to become the most common cause of irreversible vision impairment and blindness worldwide and also in Europe. These prevalence estimates indicate the importance of reducing the burden of myopia by means of myopia control interventions to prevent myopia onset and to slow down myopia progression. Due to the urgency of the situation, the European Society of Ophthalmology decided to publish this update of the current information and guidance on management of myopia. The pathogenesis and genetics of myopia are also summarized and epidemiology, risk factors, preventive and treatment options are discussed in details.

Pathological myopia is a severe case of myopia, i.e., nearsightedness. Pathological myopia is also known as degenerative myopia because it ultimately leads to blindness. In pathological myopia, certain myopia-specific pathologies occur at the eye’s posterior i.e., Foster-Fuchs’s spot, Cystoid degeneration, Liquefaction, Macular degeneration, Vitreous opacities, Weiss’s reflex, Posterior staphyloma, etc. This research is aimed at developing a machine learning (ML) approach for the automatic detection of pathological myopia based on fundus images. A deep learning technique of convolutional neural network (CNN) is employed for this purpose. A CNN model is developed in Spyder. The fundus images are first preprocessed. The preprocessed images are then fed to the designed CNN model. The CNN model automatically extracts the features from the input images and classifies the images i.e., normal image or pathological myopia. The best performing CNN model achieved an AUC score of 0.9845. The best validation loss obtained is 0.1457. The results show that the model can be successfully employed to detect pathological myopia from the fundus images.

Three patients with pathological myopia(PM) due to both active macular choroidal neovascularization (CNV) and macular retinoschisis (MRS) in the same eye were treated by photodynamic therapy for CNV. The patients were evaluated before and after photodynamic therapy (PDT) treatment by best corrected visual acuity (BCVA), color fundus photography, optical coherent tomography (OCT), and fundus fluorescein angiography (FFA) when necessary. The patients were followed for 120, 94, 34 months. Besides the therapeutic effect of PDT to CNV, we observed healing of the MRS in all 3 patients.

Automatic detection of myopia plays a significant role in clinical practice. Few studies have been done on the detection of pathological myopia, and no attention has been paid to the distinguishment between it and high myopia. Additionally, they are hard to differentiate because of the high similarity between them. In this paper, we design a network with two branches for different classification tasks, where the first one is to distinguish the normal and abnormal while the other is to classify pathological myopia and high myopia. We manage to improve the classification accuracy by combining Binary Cross-Entropy loss and Triplet loss. Extensive experiments are conducted for comparison between our method and other universal classification models using a private retinal fundus dataset. The results demonstrate that our method achieves the best performance with 81.82%, 83.61% and 83.52% on the accuracy, precision and sensitivity, respectively.

Pathological Myopia (PM) is one among the main reason of visual defect in the world. Pathological myopia is associated with decaying changes in the retina. If it remains untreated it may lead to vision loss that can’t be recoverable. The correct diagnosis of pathological myopia will facilitate proper treatment and improve disease management which reduce the growth of the disease. However, it is nearly impossible to scan the whole population. Computer-aided diagnosing tools in eye image study will build the method scalable and economical. This paper focuses on the problems of classification of Pathological myopia images and non-pathological myopia images and optical disc, fovea detection, localization, lesions (atrophy and detachment) segmentation with 400 samples provided by International Symposium on Biomedical Imaging (ISBI). In this paper, a deep learning method with Convolutional Neural Networks (CNN) is used for classification and U-net model is used for Image segmentation which shows that it achieves highly competitive results.

Pathological myopia, potentially causing loss of vision, has been considered as one of the common issues that threatens visual health of human throughout the world. Identification of retinal lesions including atrophy and detachment is meaningful because it provides ophthalmologists with quantified reference for accurate diagnosis and treatment. However, segmentation of lesions on fundus photography is still challenging because of widespread data and complexity of lesion shape. Fundus images may vary from each other distinctly as they are taken by different devices with different surroundings. False positive predictions are also inevitable on negative samples. In this paper, we propose originally invented lesion-aware segmentation network to segment atrophy and detachment on fundus images. Based on the existing architecture of paired encoder and decoder, we introduce three innovations. Firstly, our proposed network is aware of existence of lesion by including an extra classification branch. Secondly, feature fusion module is integrated to the decoder that makes the output node sufficiently absorbs the features in various scales. Last, the network is trained with an elegant objective function, called edge overlap rate, that eventually boosts the model's sensitivity of lesion edges. The proposed network wins PALM challenge in ISBI 2019 with a large margin, that could be seen as evidence of effectiveness. Our team, PingAn Smart Health, leads the leaderboards in all metrics in scope of lesion segmentation. Permission of using the dataset outside PALM challenge was issued by the sponsor.

Coexistent choroidal neovascular membrane and macular hole with serous retinal detachment in pathological myopia is a rare entity and may be quite challenging to manage. We present such a case managed with bevacizumab injection and vitrectomy. Although the retina was attached at the final follow-up, the visual outcome was poor, due to non-closure of hole.

Background Myopic choroidal neovascularization (CNV) is the most common sight-threatening complication associated with high myopia. The present study evaluated the efficacy and safety of the intravitreal injection of ziv-aflibercept in patients with myopic CNV. Methods This prospective interventional study was conducted on 20 eyes of 20 patients with active myopic CNV. Twelve patients were 40 years or older. This study was performed in the Ophthalmology Department of Tanta University Eye Hospital, Tanta University, Egypt. Optical coherence tomography (OCT) was performed for all patients at baseline and monthly after injection during the 6-month follow up period. The main outcome measures were changes in BCVA and CMT. The exploratory outcome measures were CNV size, IOP and the number of injections needed in each age group during the study period. Results Patients with myopic CNV younger than 40 years needed fewer injections (2.00 ± 0.76) than patients older than 40 years (2.50 ± 1.00), with no statistical significance detected between the two groups (p-value 0.246). CNV was smaller in the younger age group (p-value 0.209), best corrected visual acuity (BCVA) improved significantly in the younger and older age groups (p-values 0.001 and 0.028, respectively), and central macular thickness (CMT) decreased significantly after 6 months, from 242.88 ± 23.83 μm to 191.13 ± 13.83 μm in the younger age group and from 251.33 ± 26.60 μm to 197.08 ± 17.64 μm in the older age group (p = 0.001). No significant correlation was found between the final BCVA and either the spherical equivalent or central macular thickness after 6 months, with p-values of 0.135 and 0.145, respectively. No significant changes in IOP were detected in either group after the intravitreal injection. Conclusion Ziv-aflibercept is a highly effective and safe drug in cases of active myopic CNV; however, a larger number of patients and a longer follow-up period are needed to confirm our results. This study was retrospectively registered at clinicaltrials.gov (ID: NCT04290195) on 26-2-2020.

Aim of the Work The aim of this work is to compare the response of treatment with ranibizumab in terms of visual acuity in cases of CNV secondary to pathological myopia versus CNV secondary to age-related macular degeneration. Methods This prospective, comparative study included ten eyes newly diagnosed as having CNV secondary to pathological myopia, and 10 eyes newly diagnosed as having subfoveal active CNV secondary to AMD. All patients had 3 monthly intravitreal Injections of 0.50 mg (in 0.05 ml of solution) ranibizumab with monthly evaluation of best corrected visual acuity (BCVA) by Landolt C chart, and also calculated in Logarithm of Minimum Angle of Resolution (Log MAR). Results pretreatment there was no significant difference between the two groups as the mean VA (Log Mar) was 1.31 ± 0.2 in AMD group and 1.17 ± 0.3 in MCNV group of P value = 0.431 and also post three IVI of ranibizumab showed no significant difference between the two groups as the mean VA (Log Mar) was 1.22 ± 0.2 for AMD and 1.22 ± 0.5 for MCNV of P value = 0.635. Conclusion there was no significant difference in BCVA between AMD and MCNV groups after three intravitreal injections of ranibizumab.

To assess the effects of posterior sclera reinforcement (PSR) in refractive outcomes, choroidal thickness (CT), and retinal thickness (RT) during a 3-year follow-up in eyes with pathological myopia. Thirty-eight eyes of 26 adults with pathological myopia who underwent PSR (the PSR group) and 30 eyes of 18 adults with matched age and myopia who did not receive PSR treatment (the control group) were followed up with measurements of axial length (AL), spherical equivalent (SE), best corrected visual acuity (BCVA), CT, and RT at baseline, 1 and 3 months, and 1, 2, and 3 years postoperatively. Data were analyzed by repeated measures analysis of variance and independent-samples t test. In the PSR group, AL, SE, BCVA, and CT were tending to be relatively stable and no statistically significant changes were found during the follow-up (all P > 0.05). In contrast, in the control group, compared with the measurements taken at baseline, AL, SE, BCVA, and CT altered gradually from 1 month onward to 3 years postoperatively. At 2-year and 3-year follow-ups, significant differences in AL, SE, BCVA, and CT were noted between the PSR group and the control group (all P

PURPOSE: To study UK practice patterns for the management of retinal detachment secondary to macular hole (MHRD) and macular retinoschisis (MRS) in pathological myopia (PM). To review the anatomical and visual outcomes of the surgically managed cases. METHODS: A prospective observational case series for the management of MHRD was undertaken in association with the British Ophthalmological Surveillance Unit (BOSU). The results were combined with retrospective data, collected by the COllaboration of British RetinAl Surgeons (COBRA), on the management of both MHRD and MRS in PM in the UK. A total of 20 cases of MHRD and 53 cases of MRS (27 surgical cases and 26 cases managed conservatively) are reported in this combined study. RESULTS: MHRD: Mean baseline best corrected visual acuity (BCVA) was 1.60 logMAR. All cases underwent pars plana vitrectomy (PPV). Mean post-operative BCVA was 1.49 logMAR (p = 0.674). The macular hole was closed in 5/20 (25%) cases, open/flat in 10/20 (50%) cases and open/elevated in 4/20 cases (20%). MRS: Mean baseline BCVA was 0.87 logMAR in the surgical group and 0.45 logMAR in the conservatively managed group (p = 0.002). All eyes that had surgical intervention underwent PPV. Mean post-operative BCVA was 0.68 logMAR (p = 0.183). Anatomical outcomes demonstrated a persistent MRS in 2/27 (7.4%) cases, partial resolution in 7/27 (25.9%) cases and complete resolution in 16/27 (59.2%) cases. CONCLUSIONS: PPV is the only surgical procedure performed for the management of MHRD and MRS amongst the study participants. Success rates and visual outcomes are limited for MHRD and consistent with the current literature for MRS.

There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80-90%, and an accompanying high prevalence of high myopia in young adults (10-20%). This may foreshadow an increase in low vision and blindness due to pathological myopia. These two epidemics are linked, since the increasingly early onset of myopia, combined with high progression rates, naturally generates an epidemic of high myopia, with high prevalences of "acquired" high myopia appearing around the age of 11-13. The major risk factors identified are intensive education, and limited time outdoors. The localization of the epidemic appears to be due to the high educational pressures and limited time outdoors in the region, rather than to genetically elevated sensitivity to these factors. Causality has been demonstrated in the case of time outdoors through randomized clinical trials in which increased time outdoors in schools has prevented the onset of myopia. In the case of educational pressures, evidence of causality comes from the high prevalence of myopia and high myopia in Jewish boys attending Orthodox schools in Israel compared to their sisters attending religious schools, and boys and girls attending secular schools. Combining increased time outdoors in schools, to slow the onset of myopia, with clinical methods for slowing myopic progression, should lead to the control of this epidemic, which would otherwise pose a major health challenge. Reforms to the organization of school systems to reduce intense early competition for accelerated learning pathways may also be important.

Background/AimsThe aim of this study was to evaluate the usefulness of several optical coherence tomography (OCT) findings to estimate choroidal neovascularisation (CNV) activity in pathological myopia using fluorescein angiography (FA) as a reference.MethodsThis was a single-centre, retrospective study. The medical records of patients with active myopic CNV who received intravitreal bevacizumab treatment were reviewed. Parameters to monitor CNV activity were morphological features of CNV on OCT, such as CNV height, central foveal thickness, intraretinal cysts, subretinal fluid, fuzziness of the CNV border, CNV network area on FA, and haemorrhage or exudation on fundus photo.ResultsThere were 46 patients with active CNV enrolled in this study. After intravitreal bevacizumab treatment, all the previously mentioned parameters of CNV were significantly improved. Using logistic regression analyses with backward elimination, the fuzzy border seen on OCT showed the most significant correlation with improvement of leakage on FA, when compared with other variables such as intraretinal cysts, subretinal fluid or central foveal thickness (R2=0.324, p=0.009).ConclusionOur study showed that the fuzziness of the hyper-reflective CNV margin showed the most significant improvement and the strongest correlation with the improvement of CNV leakage on FA after intravitreal bevacizumab injections, suggesting its important role as an OCT parameter for the assessment of myopic CNV activity.

BACKGROUND Impairment in vision is a worldwide problem of socio-economic significance. This study was carried out with objective of analysing various causes of permanent visual disability in North West rural Tamilnadu, India. MATERIALS AND METHODS The study was done by evaluating 150 cases of permanent visual disability patients who came to ophthalmology OPD Department at Government Dharmapuri Medical College. Patients with permanent visual disability underwent ocular examination including visual acuity, anterior segment evaluation with oblique illumination and slit-lamp evaluation, retinoscopy and fundus examination with post mydriatic test to identify the cause of permanent disability. RESULTS In this study, permanent visual disability is equally distributed with mild increase in males (53%). The majority of the permanently disabled are found in age group between 15 and 45 years (57%), followed by age group 46 - 60 years (21%), 17% are more than 60 years (17%) of age and 5% are less than fifteen years of age. In the study, one-half of the disabled persons are 100% blind and one-quarter (23%) are one eyed. 11% are 75% visually disabled and 17% had 40% visual disability. In the study corneal blindness (27%) and retinitis pigmentosa (15%) are the top two causes of bilateral permanent and 80% of all unilateral blindness result from some type of injury to one eye. CONCLUSION In this study we conclude that the present visual disability due to diabetic retinopathy, glaucoma and pathological myopia could have been avoided or delayed if promptly diagnosed and treated at an earlier stage. Also the time between injury and treatment by ophthalmologist plays a main role in unilateral blindness due to injury.

Background The current standard treatment of choroidal neovascularisation (CNV) secondary to pathological myopia (PM) is intravitreal injection of VEGF antagonists. We now present our 6-year results after treating patients with CNV secondary to PM with ranibizumab. Patients and Methods We retrospectively analysed 15 treatment-naive eyes of 13 patients (10 women, 3 men, mean age 59.2; standard deviation (SD) 11.1; range 41–78 years) with visual impairment related to CNV secondary to PM, who were treated with at least 1 injection of ranibizumab. Follow-up treatments were indicated according to our PRN (pro re nata) regimen. Re-treatment criteria were: reduction in visual acuity and/or activity in OCT or fluorescence angiography. Results Patients received a mean of 3.5 ranibizumab injections (SD 3.4; range 1–12) during a mean follow-up of 85 months (SD 6.6; range 76–102 months). Initial spherical equivalent was − 12.4 ± 4.0 dpt (range − 7.5 to 20.5 dpt). Baseline visual acuity was (log MAR) 0.65 ± 0.28. After one month, visual acuity improved to 0.43 ± 0.23 (p = 0.002), after 3 months to 0.38 ± 0.22 (p = 0.002), after 6 months to 0.34 ± 0.22 (p = 0.002) and after 9 months to 0.35 ± 0.23 (p = 0.002). After 1 year, visual acuity was 0.35 ± 0.24 (p = 0.001), after 2 years 2 0.35 ± 0.23 (p = 0.001), after 3 years 0.35 ± 0.23 (p = 0.002), after 4 years 0.37 ± 0.23 (p = 0.002), after 5 years 0.38 ± 0.23 (p = 0.002), and after 6 years 0.39 ± 0.26 (p = 0.016). Conclusion After considerable initial improvement in visual acuity, the initial gain was maintained by a strict PRN regimen for the observation and treatment of patients with neovascular membranes secondary to pathological myopia. The number of injections needed to achieve stable visual acuity was lower than with other diseases that respond to anti-VEGF.

BackgroundPeripheral Retinal neovascularization is well-described as a complication of X-linked retinoschisis, but less often observed in myopic and primary retinoschisis. We present a case of a myopic female who developed retinal microvascular abnormalities due to retinoschisis and subsequent vitreous hemorrhage which would cause severe visual damage without timely and proper treatment.Case presentationA 38-year-old highly myopic Chinese female complained of blurred vision in her right eye. Her best corrected visual acuitiy was 20/20 OU, and her refraction was − 9.00S OU. Dilated fundus examination revealed mild vitreous hemorrhage and abnormal vascular network nasal to the optic disc in her right eye. Optical Coherence Tomography (OCT)- angiography (OCTA) B-Scan showed superficial retinoschisis and well-depicted abnormal retinal microvascular network in inner retinal layer. Sectoral scatter laser photocoagulation was administered. Regression of most abnormal vessels was achieved in 1 month, but the patient experienced an unexpected episode of vitreous hemorrhage 3 months after the initial treatment, which was absorbed spontaneously in 2 weeks. Supplemental laser photocoagulation was applied and regular follow-up visit was suggested.ConclusionSuperficial retinoschisis in pathological myopia can be a driver of retinal microvascular abnormalities, possibly neovascularization, an extremely rare but severe complication which can be vision-threatening without timely and proper intervention.

Perifoveal exudative vascular anomalous complex (PEVAC) is a peculiar and rare clinical entity that does not fit into any other previously described macular disease, defined by the presence of a unilateral, isolated perifoveal aneurysm in otherwise healthy patients. By definition, PEVAC occurs in subjects without any signs of arterial hypertension, diabetes, or any other systemic or local vasculopathy; however, eyes with PEVAC may manifest other macular diseases including age-related macular degeneration (AMD) (40% of cases) or pathological myopia (13% of cases). No other coincident retinal diseases have been detected. Age of diagnosis is variable; both young people, and more frequently, aged subjects could be affected (mean age at onset is 71 ± 13 years) (Sacconi et al. 2017).

Given the prevalence of myopia has been increasing significantly across the world, especially in East Asia, great challenges have been raised for myopia correction and the management of pathological myopia. Delaying the onset of myopia will likely reduce the prevalence of myopia as well as high myopia in school-aged children. Prevention of the onset of myopia is therefore an important priority. This chapter focuses on the clinical strategy to prevent or delay the onset of myopia among school-aged children, summarizing the interventions currently available, including increased time outdoors, reduced near work, latest optical interventions, eye exercises of acupoints, and takes a glance at future perspectives.

Pathological Myopia (PM) is one of the leading cause of blindness all over the world and is particularly prevalent in Asia. Pathological myopia is a severe case of myopia which is accompanied by degenerative changes in the retina and can lead to non recoverable vision loss. The accurate diagnosis of PM will enable timely intervention and better treatment planning. Current methods for the detection of pathological myopia are manual and subjective. In this study, we have developed a Convolutional Neural Network (CNN) based system to estimate probability/risk of the patient to be diagnosed with PM from his retinal images. We have also segmented optic disc from the retinal images with novel Residual UNet architecture. Validation data results are evaluated from the online server and achieved 0.9973 and 0.901 for the task of PM classification and optic disc segmentation respectively.

Praveen Subudhi,1,2 Sweta Patro,1 Zahiruddin Khan,2 B Nageswar Rao Subudhi,3 Silla Sitaram4 1Department of Cornea and Refractive Surgery, Ruby Eye Hospital, Berhampur, Odisha, India; 2Ophthalmology Department, Hitech Medical College, Bhubaneswar, India; 3Ophthalmology Department, MKCG Medical College and Hospital, Berhampur, Odisha, India; 4Ophthalmology Department, SDH, Chatrapur, Odisha, IndiaCorrespondence: Praveen SubudhiRuby Eye Hospital, Govinda Vihar, Sushruta Nagar, Ganjam, Berhampur 760001, Odisha, IndiaEmail subudhipraveen@gmail.comPurpose: To assess the safety and efficacy of implanting implantable phakic copolymer lenses (IPCLs) with peripheral optic holes in the intraocular posterior chamber in Indian patients with moderate to high myopia.Methods: Seventy-five eyes of 50 patients who underwent IPCL implantation were retrospectively analyzed. Preoperative parameters, such as subjective refraction, anterior chamber depth (measured using a pentacam), and white-to-white diameter were measured. A custom-made IPCL using the aforementioned parameters was then implanted in the sulcus to correct moderate to high myopia. All patients had undergone neodymium-doped yttrium aluminum garnet peripheral iridotomy.Results: Clinical outcome data were collated retrospectively from the medical case records of the patients. The mean age was 25.36 years (standard deviation [SD]: 3.60 years), and 55.55% of the patients were men. The mean preoperative best-corrected visual acuity (BCVA) was 0.367 logmar units (SD: 0.266, max: 0.0 and min: 1.2). The post-IPCL implantation mean uncorrected visual acuity was 0.225 logmar units (SD: 0.172, max: 0 and min: 0.7), which was significantly superior to the preoperative BCVA (P=

Purpose: To report a single case history of scleral rupture (SR) during silicone oil injection in a pars plana vitrectomy. Observations: A 60-year-old woman with a history of pathological myopia presented with acute vision loss in her right eye. A retinal detachment, with multiple tears, was diagnosed, and she underwent vitreoretinal surgery. During silicone oil injection, a SR, with extra ocular oil leakage, was advised. Due to the small extent of the lacerated area, the SR was left to spontaneously resolve and, after three surgeries, the retina remained attached, with no internal tamponade, and the patient had not presented symptoms or signs of intracranial migration or toxicity. Conclusions and importance: During silicone oil injection, it is most important to maintain a controlled eyeball pressure, especially in patients with scleral weakness, and to carefully check the drainage of air, due to the risk of SR. When oil leakage is detected in the orbital cavity, an accurate assessment may be required due to the likelihood of progression inside the intracranial structures. Keywords: Intraoperative complication, Pathological myopia, Scleral rupture, Serious myopia, Silicone oil

The present study aimed to investigate whether optical coherence tomography angiography (OCTA) could be used to guide the treatment of pathological myopic patients with submacular hemorrhage. Two pathological myopia patients with submacular hemorrhage were examined. Initially, choroidal neovascularization (CNV) was not observed during fundus angiography in both patients. However, based on OCTA, the first patient was diagnosed with myopic lacquer crack-related macular hemorrhage, and the second with CNV secondary to punctate inner choroidopathy. The first patient was treated with traditional Chinese medicine administered orally, and the second with intravitreal injections of anti-vascular endothelial growth factor (VEGF). Lesions in both patients were resolved. Submacular hemorrhage in pathological myopia patients could be caused by numerous mechanisms. OCTA is useful in differentiating inflammatory CNV from inflammatory lesions, particularly if CNV is not detected using other multimodal imaging techniques.

Background/Purpose: This study aims to evaluate the clinical characteristics and visual outcome of macular hemorrhage in pathological myopia with or without choroidal neovascularization. Methods: We conducted a retrospective study of 55 patients with macular coin hemorrhage who were followed for at least 3 months from January 1997 to December 2013 at Shin Kong Wu Ho-Su Memorial Hospital (Taipei, Taiwan). All patients were evaluated using fluorescein angiography and optical coherence tomography for the detection of choroidal neovascularization (CNV). We also recorded clinical characteristics such as age, sex, refractory error, and myopic fundus, to determine the relationship between CNV and non-CNV associated macular hemorrhage. Results: A total of 55 patients (30 females, 54.55%) were reviewed. The mean age was 39.7 years old. The CNV group was found to be significantly older than the non-CNV group (p < 0.05), and there was no significant difference between sex, visual acuity myopic severity, and the prevalence of fundus findings between CNV and non-CNV groups. Twenty one patients (38.18%) were found to have CNV and were all treated with intravitreal antivascular endothelial growth factor (VEGF). The other 34 patients without CNV were not treated. In both groups, the visual acuity significantly improved (anti-VEGF treated, CNV associated group, 0.7 to 0.39, p = 0.002, and untreated, non-CNV associated group, 0.56 to 0.34, p = 0.0018, respectively). Conclusion: Age significantly correlated to the CNV formation in high myopia with macular hemorrhage. Favorable visual outcomes were found in pathological myopic macular hemorrhage either in the anti-VEGF treated, CNV associated group or in the untreated, non-CNV associated group.

Discovering a relationship between axial length and vitreous volume would be helpful since the axial length is easier to measure than magnetic resonance imaging (MRI) parameters. This study aimed to analyze the topography of human eyes with pathological myopia through volume rendering images by high-resolution 3D-MRI and to establish a model to estimate the vitreous volume. This was a retrospective, non-randomized, controlled study of patients evaluated at Tongren Hospital from July 7, 2007 to December 12, 2018. The controls were emmetropic volunteers. All participants underwent ophthalmic examinations. Axial length was measured with an IOL Master. High-resolution 3D MRI and volume rendering was utilized for all the eyes. Logistic regression was used to establish a model to predict the vitreous volume. A total of 280 emmetropic eyes and 290 eyes with pathological myopia were included. Males represented 60.7% and 65.5% of the individuals. The mean axial lengths of those two groups were 23.1 ± 0.8 mm (95%CI: 22.7–23.4 mm) and 28.3 ± 2.2 mm (95%CI: 27.5–29.2 mm), respectively (P

BACKGROUND: This study aimed to investigate differentially expressed proteins in the vitreous humor (VH) of pathological myopia (PM) and normal eyes. METHODS: VH samples were collected from patients undergoing surgical treatment for rhegmatogenous retinal detachment (RRD), idiopathic epiretinal membrane (ERM), myopic retinoschisis (MRS) or macular hole (MH). A label-free quantitative proteomic analysis was performed to detect the differentially expressed proteins, and expression of three differentially expressed proteins was confirmed by ELISA. RESULTS: In PM patients (MH-PM, MRS-PM and RRD-PM), the expression of prostaglandin-H2 D-isomerase (PGDS) and glutathione peroxidase 3 (GPX3) was significantly lower than in controls (MH, ERM, and RRD). The versican core protein expression decreased in the PM group. The vitreous concentrations of PGDS and GPX3 in patients with axial length (AL) of 26.5–29.0 mm were higher than in patients with AL >29.0 mm or AL 29.0 mm. CONCLUSIONS: Our study provides new evidence on the molecular changes in the VH of PM patients, and these molecules have the potential to become new targets for the therapy of PM.

Myopia is an important public health problem due to its prevalence and significant public health cost. Elevating levels of myopia increase the risk of vision impairment, and therefore, high myopia has become one of the main causes of untreatable vision loss throughout the world due to its irreversible complications. At present, many options for slowing progression of myopia have already been proposed and evaluated such as progressive addition of executive bifocal spectacle lenses, peripheral defocusing lenses, overnight orthokeratology, pharmacological agents such as atropine eye drops, and multifocal soft contact lenses (MFSCLs). Use of MFSCLs has especially increased in recent years due to the growing demand to slow myopia progression during patient's adolescent growth period to avoid pathological myopia in adulthood. Compared with the other traditional methods of controlling myopia, MFSCLs allow myopic patients to better maintain their clear visual quality and slow myopia progression. In this manuscript, we aim to review the basics of myopia, recent advances in contact lenses to control myopia with emphasis on MFSCLs, define the elements for proper MFSCL fittings (such as pupil size, aberrations, accommodation and centering), discuss the potential rebound effect after discontinuation of contact lenses, and future directions for improvements of contact lenses for the control of myopia.

Myopia, a worldwide condition, is a multifactorial disease resulting in many ocular complications. Early onset of myopia has a great tendency to develop high myopia and pathological myopia later in life. The pathophysiology and progression of myopia is still unclear. Owing to its involving in visual function, optic disc and peripapillary change in high myopia can't be neglected, and it may help in better understanding of the pathophysiology or mechanism of myopia progression. Recently, advanced imaging techniques have been developed, such as optical coherence tomography (OCT), allowing for better detecting of optic disc and peripapillary change. OCT is a high-resolution and noninvasive measurement for detection of ocular structure. Herein, we provide an updated review of optic disc and peripapillary change in OCT image, including its characteristics and clinical significance. We also propose some problems needed further investigation.