Universit degli studi di Udine Cattedra di oftalmologia Dir. Prof. U. Menchini
MYOPICMACULAR DEGENERATION
CLINICAL ASPECTS and THERAPY
ALFREDO PECEESKIMOTAIWAN68%75%RACIAL AND ETHNIC VARIATIONS
PREVALENCE OF MYOPIA
AgeIn Taiwan (1995)7 years old: 12%12 years old: 56%15 years old: 76%18 years old: 84%In western countries20 years old: 20%
DEGENERATIVEMYOPIA 1.7-2.1% of the population 27-33% of the myopic eyesSOCIOECONOMIC AND ENVIROMENTAL FACTORSTHE PREVALENCE OF MYOPIA INCREASES AS THE LEVEL OF EDUCATION RISES STUDENTS 32% FARMWORK,FISHERMEN 2.5%GOLDSCHMIDT 1968SCHOOLCHILDREN AGED 7-9 SINGAPORE 37% XIAMEN-CHINA 18.5%
P< .0.5
P< .01
B.Freund, A.Ciardella, L.Yannuzzi, A.Pece. PERIPAPILLARY DETACHMENT IN PATHOLOGIC MYOPIA. Arch of Ophthalmol, 2003;121:197-204 Meno di 50 anni
miopia62%POHS12%strie angioidi5%altre4%idiopatica17%Patologie causa di CNVOltre 50 anni: AMD
STAPHYLOMAPOSTERIOR POLEMACULARPERIPAPILLARYNASALINFERIOR
POSTERIOR POLE STAPHYLOMA44%
MACULAR STAFYLOMA3%
13%
20%20%
Peripapillary crescent
By Centervue
CNV FROM THE CRESCENT
By OPTOS
CHORIORETINAL AREAS OF ATROPHY
CHORIORETINAL AREAS OF ATROPHY
lacquer cracks
RetinographyRed-freeBluRedFAG
COIN LESION
1 mo. later2 mo.later2 y laternatural evolution
LACQUER CRACKS PROGRESSIN 56%K.OHNO-MATSUI ET COLL RETINA 16:29-37, 1996.LACQUER CRACKS & CNV
CNV AFFECT 5-10% OF THE MYOPIC POPULATIONCNV
58-74% OF CNV DIRECTLY INVOLVE THE FOVEA ONINITIAL EXAMINATIONCNV
CNV a marginimal delimitatiCNV a marginiben delimitatiLeakage evidente o scarso
Ruolo dellICG
Ruolo dellICG= limitato
CNV in myopic macular degeneration
B
Initial FAMiddle FALate FAIRAF
P.Milani et Al: Importance of SDOCT in Myopic CNV
Courtesy P.Milani35OCT IS HELPFUL for the DIAGNOSISMyopic CNV often small, mild leakageMyopic Fundus.StaphilomaMultiple areas of chorioretinal atrophyTassellation-distrophy of the RPE
There may be angiographic diagnostic difficulties even when using the SLO which gives more contrast and better definition
VISION DISTURBANCES SINCE 2 WEEKS, UNCERTAIN LEAKAGECNV PRESENCE ?P. Milani37CNV nella PM: diagnosi differenziale
CNV nella PM: diagnosi differenziale
Storia naturale della CNV nella PMPerdita visiva 1/2 degli occhi dopo 2 anni 2/3 degli occhi dopo 5-10 anni
Involuzione spontanea con buon esito funzionale RARA
NATURAL EVOLUTION
15 years later
New Therapies in MYOPIC-CNV
1DIAGNOSI CORRETTA
Myopic CNV
2QUALE TERAPIA?Laser photocoagulation of non-subfoveal myopic CNV 1) Soubrane 1986, 2)Fardeau 1992, 3) Secretan 1997Randomized studies (1,2): effective but VA decreases during the time. No benefit at 5 years Retrospective studies (3): VA decrease 42% (5 years) up to 63% (10 years) in treated vs 68% in untreatedNO MORE LASER
2 y after laser 4 y after laser 4 mo after laserVIP Trial: Patients with Pathologic Myopia Primary Visual Acuity Outcome 8040200P=0.00360Verteporfin (n = 81)Placebo(n = 39)Verteporfin-treated patients were more likely to have stabilized vision (defined as losing