Abstract
Objective
The aim of this study was to clarify the characteristic findings in myopic choroidal neovascularization (CNV) and the relationship with lacquer crack (LC).
Methods
In all, 66 consecutive myopic CNV patients treated with photodynamic therapy and/or intravitreal anti-vascular endothelial growth factor injection in one eye were reviewed. Data from fluorescein angiography (FA) and indocyanine green angiography (ICGA), obtained simultaneously using the Heidelberg retina angiograph 2 (HRA2), were analyzed.
Results
LCs were associated with a relatively large extent (≥3000 μm) of peripapillary choroidal atrophy and a dark rim, the proliferation of retinal pigment epithelial cells surrounding the neovascular membrane was accompanied by a small extent. Myopic CNV usually developed in the LC area surrounded by tiny crack fragments. In all, 35 patients with LCs received FA and ICGA at least twice during follow-up. LC progression was observed in nine (25.7%) treated eyes and six (23.1%) non-CNV fellow eyes. Crack fragments progressed in three distinct forms such as elongation, branching, or bridging pattern. Newly diagnosed myopic CNV was reported in 18 treated eyes and 3 fellow eyes. Progression of LCs and development of CNV occurred simultaneously in eight eyes. By multivariate Cox's regression, a statistically significant association was observed between recurrence of myopic CNV and the absence of a dark rim on ICGA.
Conclusions
The HRA2 instrument affords detailed high-resolution images of FA and ICGA. Notably, recurrence of myopic CNV developed in areas surrounded by new small crack fragments and LCs are considered to be important in the development of myopic CNV.
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References
Iwase A, Araie M, Tomidokoro A, Yamamoto T, Shimizu H, Kitazawa Y, Tajimi Study Group. Prevalence and causes of low vision and blindness in a Japanese adult population: the Tajimi Study. Ophthalmology 2006; 113: 1354–1362.
Cotter SA, Varma R, Ying-Lai M, Azen Sp, Klein R, Los Angeles Latino Eye Study Group. Causes of low vision and blindness in adult Latinos: the Los Angeles Latino Eye Study. Ophthalmology 2006; 113: 1574–1582.
Lin LL, Shih YF, Hsiao CK, Chen CJ . Prevalence of myopia in Taiwanese schoolchildren: 1983 to 2000. Ann Acad Med Singapore 2004; 33: 27–33.
Wong TY, Foster PJ, Hee J, Ng TP, Tielsch JM, Chew SJ et al. Prevalence and risk factors for refractive errors in adult Chinese in Singapore. Invest Ophthalmol Vis Sci 2000; 41: 2486–2494.
Hofman A, Grobbee DE, de Jong PT, van den Ouweland FA . Determinants of disease and disability in the elderly: the Rotterdam Elderly Study. Eur J Epidemiol 1991; 7: 403–422.
Wang Q, Klein BE, Klein R, Moss SE . Refractive status in the Beaver Dam Eye Study. Invest Ophthalmol Vis Sci 1994; 35: 4344–4347.
Attebo K, Ivers RQ, Mitchell P . Refractive errors in an older population: the Blue Mountains Eye Study. Ophthalmology 1999; 106: 1066–1072.
Curtin BJ, Karlin DB . Axial length measurements and fundus changes in the myopic eye. Am J Ophthalmol 1971; 71: 42–50.
Noble KG, Carr RE . Pathologic myopia. Ophthalmology 1982; 89: 1099–1100.
Avila MP, Weiter JJ, Jalkh AE, Trempe CL, Pruett RC, Schepens CL . Natural history of choroidal neovascularization in degenerative myopia. Ophthalmology 1984; 91: 1573–1581.
Hampton GR, Kohen D, Bird AC . Visual prognosis of disciform degeneration in myopia. Ophthalmology 1983; 90: 923–926.
Grossniklaus HE, Green WR . Pathologic findings in pathologic myopia. Retina 1992; 12: 127–133.
Ohno-Matsui K, Yoshida T, Futagami S, Yasuzumi K, Shimada N, Kojima A et al. Patchy atrophy and lacquer cracks predispose to the development of choroidal neovascularisation in pathological myopia. Br J Ophthalmol 2003; 87: 570–573.
Quaranta M, Arnold J, Coscas G, Français C, Quentel G, Kuhn D et al. Indocyanine green angiographic features of pathologic myopia. Am J Ophthalmol 1996; 122: 663–671.
Brancato R, Trabucchi G, Introini U, Avanza P, Pece A . Indocyanine green angiography (ICGA) in pathological myopia. Eur J Ophthalmol 1996; 6: 39–43.
Ohno-Matsui K, Morishima N, Ito M, Tokoro T . Indocyanine green angiographic findings of lacquer cracks in pathologic myopia. Jpn J Ophthalmol 1998; 42: 293–299.
Axer-Siegel R, Cotlear D, Priel E, Rosenblatt I, Snir M, Weinberger D . Indocyanine green angiography in high myopia. Ophthalmic Surg Lasers Imaging 2004; 35: 139–145.
Ikuno Y, Sayanagi K, Soga K, Sawa M, Gomi F, Tsujikawa M et al. Lacquer crack formation and choroidal neovsacularization in pathologic myopia. Retina 2008; 28: 1124–1131.
Yasuzumi K, Ohno-Matsui K, Yoshida T, Kojima A, Shimada N, Futagami S et al. Peripapillary crescent enlargement in highly myopic eyes evaluated by fluorescein and indocyanine green angiography. Br J Ophthalmol 2003; 87: 1088–1090.
Soubrane G, Coscas GJ . Choroidal neovascular membrane in degenerative myopia. In: Ryan SJ (ed). Retina, 4th edn. Mosby: St Louis, MO, 2005; 1136–1152.
Ladas ID, Moschos MM, Rouvas AA, Karagiannis DA, Kokolakis SN . Lacquer crack formation after photodynamic therapy. Eur J Ophthalmol 2003; 13: 729–733.
Johnson DA, Yannuzzi LA, Shakin JL, Lightman DA . Lacquer cracks following laser treatment of choroidal neovascularization in pathologic myopia. Retina 1998; 18: 118–124.
Fukushima I, Takahashi K, Nishimura T, Ohkuma H, Uyama M . Dark rim around choroidal neovascularization in indocyanine green angiography. Nippon Ganka Gakkai Zasshi 1995; 99: 1262–1270.
Yoshida T, Ohno-matsui K, Ohtake Y, Takashima T, Futagami S, Baba T et al. Long-term visual prognosis of choroidal neovascularization in high myopia: a comparison between age groups. Ophthalmology 2002; 109: 712–719.
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The abstract of this article was presented as an oral presentation at the World Ophthalmology Congress 2010.
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Kim, Y., Yoon, J. & Koh, H. The analysis of lacquer crack in the assessment of myopic choroidal neovascularization. Eye 25, 937–946 (2011). https://doi.org/10.1038/eye.2011.94
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DOI: https://doi.org/10.1038/eye.2011.94
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