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Rufino Silva; Pathologic Myopia: Natural Progression And Response To Cnv Treatment. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4460.
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© ARVO (1962-2015); The Authors (2016-present)
Introduction: Myopic maculopathy is a leading cause of vision loss in young people. The morphological and functional evolution of the disease and its relation to long-term visual prognosis and the type of treatment applied has been evaluated in some studies.Objective: To evaluate the long-term of visual prognosis and pattern of progression of myopic retinopathy in untreated high myopia and in eyes that underwent photodynamic therapy (PDT), intravitreal injection of ranibizumab (IVR) or PDT + IVR.
Retrospective observational. We analyzed the records of high myopic eyes followed in our department and treated with PDT and / or IVR: classified in 3 treated groups (PDT, IVR, IVR + PDT groups) and 1 control group (contralateral untreated eyes). All patients underwent complete eye examination with BCVA, axial length measurement, angiography, SD-OCT and autofluorescence (FAF). The progression of atrophic areas was quantified with the software RetmarkerAMD. The patterns of myopic maculopathy considered for classification of the fundus were those suggested by Hayashi et al.
We obtained records of 29 patients (54 eyes). Ten eyes (22.7%) were treated with IVR, 15 (34.1%) with PDT, 13 (29.5%) with PDT + IVR and 16 (36.4%) as control. Follow-up was 23.7 months (M) in the IVR; 103M in PDT, 83.1 M in the PDT + IVR and 79.3 M in the control group. The mean baseline BCVA in the IVR group was 60.10 ± 6.31 letters and the final BCVA was 60.50 ±20.11; in PDT group it was 43.73 ± 22.92 and 45.57 ± 25.67 letters respectively; in PDT + IVR group it was 50.7 ± 14.37 and 30.12 ± 2.50 letters and in the untreated group it was 58.50 ± 28.73 and 62.25 ± 27.26 letters. Macular atrophy: was present in the IVR group at baseline in 2 eyes (20%), and in 3 eyes at 3 years (30%) in the PDT group initially in 11 of 15 eyes (73.3%) and therefore a percentage higher than the eyes treated with IVR, but after three years the eyes of PDT have not evolved. In the IVR + PDT group 4 eyes (30.8%) had atrophy before starting treatment with PDT and 4 others developed before the IVR. In the control group, atrophy was initially in 6 eyes (37.5%) and this percentage was doubled in the follow-up. The analysis of central thickness (EMC) by OCT found the following progression: IVR: 277.9 µm to 261.7 µm (reduction); PDT: 203.75 µm to 243.8 m; PDT + IVR 249.67 to 257.25 µm and in the control group from 233.1 µm to 289.2 µm.
The results indicate that the three treatments are effective in preventing loss of AV, and roughly equivalent in relation to the degree of progression of macular atrophy. The different patterns of progression, however, affect the visual prognosis.
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