myopic macular degeneration myopic macular degeneration clinical aspects and therapy alfredo pece

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