Myopia is a highly frequent ocular disorder worldwide and pathologic myopia is the 4th most common cause of irreversible blindness in developed countries. Pathologic myopia is especially common in East Asian countries. Ocular alterations associated with pathologic myopia, especially those involving the macular area-defined as myopic maculopathy-are the leading causes of vision loss in patients with pathologic myopia. High myopia is defined as the presence of a highly negative refractive error (>-6 to -8 diopters) in the context of eye elongation (26-26.5 mm). Although the terms high myopia and pathologic myopia are often used interchangeably, they do not refer to the same eye disease. The two key factors driving the development of pathologic myopia are: 1) elongation of the axial length and 2) posterior staphyloma. The presence of posterior staphyloma, which is the most common finding in patients with pathologic myopia, is the key differentiating factor between high and pathologic myopia. The occurrence of staphyloma will, in most cases, eventually lead to other conditions such as atrophic, traction, or neovascular maculopathy. Posterior staphyloma is for instance, responsible for the differences between a myopic macular hole (MH)-with and without retinal detachment-and idiopathic MH. Posterior staphyloma typically induces retinal layer splitting, leading to foveoschisis in myopic MH, an important differentiating factor between myopic and emmetropic MH. Myopic maculopathy is a highly complex disease and current classification systems do not fully account for the numerous changes that occur in the macula of these patients. Therefore, a more comprehensive classification system is needed, for several important reasons. First, to more precisely define the disease stage to improve follow-up by enabling clinicians to more accurately monitor changes over time, which is essential given the progressive nature of this condition. Second, unification of the currently-available classification systems would establish standardized classification criteria that could be used to compare the findings from international multicentric studies. Finally, a more comprehensive classification system could help to improve our understanding of the genetic origins of this disease, which is clearly relevant given the interchangeable-but erroneous-use of the terms high and pathologic myopia in genetic research.

Purpose. To evaluate choroidal thickness in healthy pediatric population by swept-source longer-wavelength optical coherence tomography (SS-OCT). Methods. This was a cross-sectional comparative, noninterventional study. The macular area of 83 eyes from 43 pediatric patients (<18 years) was studied with an SS-OCT prototype system. Macular choroidal thickness was manually determined at 750-μm intervals by measuring the perpendicular distance from the posterior edge of the RPE to the choroid/sclera junction, along a horizontal 4500-μm line centered in the fovea. Three observers independently determined choroidal thickness. Pediatric choroidal thickness was compared with choroidal thickness from 75 eyes from 50 normal healthy adult volunteers (18 years or older). Results. Mean age was 10 ± 3 years (3–17) in the pediatric population versus 53 ± 16 (25–85) in the adult population (P < 0.001). Mean spherical equivalent was not different (P = 0.06) between both groups. Mean subfoveal choroidal thickness was 312.9 ± 65.3 μm in the pediatric versus 305.6 ± 102.6 μm in the adult population (P = 0.19). Mean macular choroidal thickness was 285.2 ± 56.7 μm in the pediatric versus 275.2 ± 92.7 μm in the adult population (P = 0.08). The distribution of choroidal thickness along the horizontal line was different for both populations; the temporal choroid was thicker in the pediatric population (320, 322, and 324 μm; P = 0.002, 0.001, and 0.06, respectively), followed by the subfoveal (312 μm) and nasal choroid (281, 239, and 195 μm). Conclusions. Macular choroidal thickness in the pediatric population is not significantly thicker than that of healthy adults. Differences are more remarkable in the temporal side of the fovea.

PURPOSE: To analyze the appearance, incidence, and characteristics of retinal diseases in myopic patients after refractive surgery. METHODS: We studied retinal disease observed in 9,239 consecutive eyes (5,099 patients) after refractive surgery. Photorefractive keratectomy (PRK) was used to correct myopia in 5,936 eyes (3,184 patients, mean age 30.5±8.9 years); mean spherical equivalent refraction was -4.71±2.80 D. Laser in situ keratomileusis (LASIK) was used to correct myopia in 3,009 eyes (1,734 patients, mean age 32.0±7.8 years); mean spherical equivalent refraction was -13.5i3.30 D. An anterior chamber phakic intraocular lens (PIOL) was implanted to correct myopia in 294 eyes (181 patients, mean age 32.6±7.3 yr) with a mean spherical equivalent refraction of -18.5*5.00 D. RESULTS: Retinal detachment occurred at a mean 53.6*41.4 months after PRK in 9 eyes (0.15%), 24.6±20.4 months after LASIK in 11 eyes (0.36%), and 20.5±17.4 months after anterior chamber PIOL implantation in 12 eyes (4.08%). Choroidal neovascularization occurred a mean 26 months after PRK in 1 eye (0.01%), mean 30.2±19.3 months after LASIK in 10 eyes (0.33%), and mean 49.0±33.5 months after PACL implantation in 7 eyes (2.38%). One patient developed a macular hole 12 months after LASIK and another patient developed a macular hemorrhage immediately after LASIK. Epiretinal membrane appeared in one patient 19 months after anterior chamber PIOL implantation. CONCLUSION: There was no relationship between PRK for myopia and retinal disease. LASIK for correction of myopia was followed by a low incidence of retinal disease; additional study is necessary to assess the true impact of the suction ring in the myopic eye. Implantation of an anterior chamber PIOL to correct high myopia was followed by a low incidence of choroidal neovascularization, a high incidence of retinal detachment, similar to other intraocular interventions in highly myopic patients. [J Refract Surg 2003;19:534-5471

Aims: The aim of the study was to examine the changes in visual acuity, fluorescein angiography (FA) and optical coherence tomography (OCT) macular thickness of subfoveal, and juxtafoveal choroidal neovascularisation (CNV) in highly myopic eyes treated by intravitreal bevacizumab. Methods: The study was a prospective, non-randomised, multicentre, interventional case series. Twenty-nine highly myopic eyes from 28 patients with subfoveal and juxtafoveal CNV were treated by three monthly intravitreal injections of 1.25 mg bevacizumab. Patients were evaluated for best-corrected visual acuity (BCVA) and OCT at baseline and then monthly for 1 year. FA was performed at baseline, after 3 months, and whenever CNV activity was suspected. Results: The average age was 50 (SD 15, range 29–82) years. The mean LogMAR BCVA at baseline was 0.55 (SD 0.25, range 0.2–1.0) and 0.38 (SD 0.32, range 0.0–1.2) at 1 year. Sixteen eyes were naïve for treatment and 13 eyes had been previously treated by photodynamic therapy (average 2.5 sessions). Leakage from CNV had ceased in all eyes at month 3. OCT central foveal thickness decreased significantly from 282 (SD 68) μm at baseline to 224 (SD 46) μm at month 12 (p = 0.008, Student t test for paired data). Six eyes needed one re-injection during follow-up at month 4 (one eye), month 6 (four eyes) and month 12 (one eye). Neither ocular nor systemic adverse reactions appeared during follow-up. Conclusions: The results of this case series suggest that intravitreal bevacizumab seems to be an effective therapeutic procedure to treat subfoveal and juxtafoveal CNV in highly myopic eyes at 1-year follow-up. Further studies are required to verify the efficacy and usefulness of this therapy compared with established treatments for this condition.

AIM To analyse the visual results obtained in the treatment of subretinal choroidal neovascularisation (CNV) in patients with high myopia by vitrectomy and extraction of the neovascular membrane. METHODS 22 eyes of 22 patients with high myopia (>−6 dioptres and/or axial length >26 mm) with subfoveal CNV treated by extraction of the CNV were analysed retrospectively. The patients' mean age was 60.27 (SD 16.41) years (range 32–83 years). The mean follow up was 29.3 (9.9) months (range 12–42 months). RESULTS Best corrected visual acuity (BCVA) preoperatively was 0.09 (0.07) (range 0.01–0.3). After treatment BCVA was 0.12 (0.10) (range 0.01–0.4), a difference without statistical significance (p=0.03, Student'st test paired data). In four cases the CNV recurred, in three cases cataract developed that required extraction, and in one case retinal detachment occurred in the early postoperative period. Topical treatment was necessary in two cases to lower the intraocular pressure. CONCLUSIONS The treatment of subfoveal CNV in highly myopic patients by surgical removal by vitrectomy does not achieve any significant improvement of the BCVA.