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