pathological myopia

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PATHOLOGICAL MYOPIA

PATHOLOGICAL MYOPIAA.JAYA KRISHNA7th SEMESTER

HISTORY OF Pathological myopia

HISTORY OF Pathological myopiaMyopia- was derived from the original Greek word mopia contracting or closing the eye.

HISTORY OF Pathological myopiaMyopia- was derived from the original Greek word mopia contracting or closing the eye.Galen was the first to use the term MYOPIA

HISTORY OF Pathological myopiaMyopia- was derived from the original Greek word mopia contracting or closing the eye.Galen was the first to use the term MYOPIAAntonio Scarpa (1801) First anatomical description of posterior staphyloma, but did not make the link to myopia

HISTORY OF Pathological myopiaMyopia- was derived from the original Greek word mopia contracting or closing the eye.Galen was the first to use the term MYOPIAAntonio Scarpa (1801) First anatomical description of posterior staphyloma, but did not make the link to myopiaCarl Ferdinand von Arlt (1856) First connected staphyloma and myopic refraction

HISTORY OF Pathological myopiaMyopia- was derived from the original Greek word mopia contracting or closing the eye.Galen was the first to use the term MYOPIAAntonio Scarpa (1801) First anatomical description of posterior staphyloma, but did not make the link to myopiaCarl Ferdinand von Arlt (1856) First connected staphyloma and myopic refraction Brian J. Curtin(1977) Classification scheme for staphyloma

HISTORY OF Pathological myopiaMyopia- was derived from the original Greek word mopia contracting or closing the eye.Galen was the first to use the term MYOPIAAntonio Scarpa (1801) First anatomical description of posterior staphyloma, but did not make the link to myopiaCarl Ferdinand von Arlt (1856) First connected staphyloma and myopic refraction Brian J. Curtin(1977) Classification scheme for staphylomaTakashi Tokoro(1988) Definition of pathologic myopia

DEFINITION OF PATHOLOGICAL MYOPIAClinically - refractive error > -6 D.Duke-Elder - Myopia with degenerative changes especially in the posterior segment.Tokoro - Myopia caused by pathological axial elongation of eye ball. A more - A rapidly progressive error which starts in childhood at specific 5-10 years of age and results in high myopia (>-6D) during early adult life which is usually associated with degenerative changes in the eye.

synonymsDegenerative myopiaProgressive myopia Malignant myopiaHigh degree myopiaMagna myopia

Prevalence of pathological myopiaCountry%Country%MyopiaSome Asian countries7090%Industrialized -West 10%25% Taiwan84%Africa1020%

Industrialized - East 60%80%India6.9%Europe and the US3040%PathologicalMyopiaAsian Countries921%Most countries 14% Spain9.6%USA2%Singapore9.1%Bangladeshi 1.8%Japan8%Czechoslovakia1%Northern China 4.1%Egypt0.2%High myopia affects 27%-33% of all myopic eyes in Asia.

Interesting factsLengthening of the posterior segment of the eye commences only during the period of active growth. The eye and the brain show precocious growth at the age of 4 years; the brain is 84% and the eye 78% and the rest of the body 21%.

After this, both the eye and the brain increase slowly while the body grows more rapidly. However, when axial myopia continues to progress, it is interpreted as a precocious growth which has failed to get arrested.!!!!!!!!!!

We do not know yet what this influence is.

Etiology of pathological myopiaThe rapid growth of axial growth of eye ball is witnessed as the main cause for the Pathological Myopia which is unequivocal and outside the normal biological variants of development.

No satisfactory theory has emerged to explain this.

But it is definitely linked with( I ). Role of Heredity, ( II ). Role of general growth process.

Role of heredityIt is now confirmed that genetic factors play a major role in the etiologyStretching of scleraMore growth of retinaGenetic Factors & General growth factorsIt is presumed that heredity linked growth of retina is the determinant in the development of myopia.

The sclera due to its distensibility stretches with retina.

But the choroid cannot and undergoes degeneration which in turn causes degeneration of Retina

Increased Axial lengthDegeneration of choroidDegeneration of RetinaDegeneration of vitreous

Family studies and twin studies have revealed the heritability of myopia since the 1960s.

In familial studies and twin studies, linkage analysis using microsatellite markers has identified 19 loci for myopia: MYP1 to MYP19.

X-Linked High MyopiaMYP1MYP13

AR High MyopiaMYP18AD High MyopiaMYP2MYP3MYP4MYP5MYP11MYP12MYP15MYP16MYP17MYP19

Common MyopiaMYP7MYP8MYP9MYP10MYP14MYP17

CLINICAL PICTUREsymptomsIMAGE MINIFICATIONANISOMETRIC AMBLYOPIASUBNORMAL VISUAL ACUITYVISUAL FIELD DEFECTSIMPAIRED DARK ADAPTATIONABNORMAL COLOR DISCRIMINATIONSUBOPTIMAL BINOCULARITYMUSCAE VOLITANTES

signsPROMINENT EYE BALLS

CORNEA IS LARGE

ANTERIOR CHAMBER IS DEEP

LARGE AND SLUGGISH PUPILS

VISUAL FIELD CONTRACTION

ERG MAY BE SUBNORMAL DUE TO CHORIORETINAL ATTROPHY

signsON FUNDUS EXAMINATIONLARGE AND PALE OPTIC DISCTILTED OPTIC NERVE WITH PERIPAPILLARY ATROPHYTEMPORAL MYOPIC CRESCENT/ PERIPAPILLARY CRESCENTTIGROID/BLOND FUNDUSCHORIORETINAL ATROPHYPERIPHERAL VITREOUS DETACHMENTLACQUER CRACKSLATTICE DEGENERATIONCOBBLESTONE DEGENERATIONFOSTER-FUCHS SPOTSPERIPHERAL RETINAL HOLESMACULAR HOLESCHOROID NEOVASCULARISATION

signsON FUNDUS EXAMINATIONLARGE AND PALE OPTIC DISCTILTED OPTIC NERVE WITH PERIPAPILLARY ATROPHYTEMPORAL MYOPIC CRESCENT/ PERIPAPILLARY CRESCENTTIGROID/BLOND FUNDUSCHORIORETINAL ATROPHYPERIPHERAL VITREOUS DETACHMENTLACQUER CRACKSLATTICE DEGENERATIONCOBBLESTONE DEGENERATIONFOSTER-FUCHS SPOTSPERIPHERAL RETINAL HOLESMACULAR HOLESCHOROID NEOVASCULARISATION

signsON FUNDUS EXAMINATIONLARGE AND PALE OPTIC DISCTILTED OPTIC NERVE WITH PERIPAPILLARY ATROPHYTEMPORAL MYOPIC CRESCENT/ PERIPAPILLARY CRESCENTTIGROID/BLOND FUNDUSCHORIORETINAL ATROPHYPERIPHERAL VITREOUS DETACHMENTLACQUER CRACKSLATTICE DEGENERATIONCOBBLESTONE DEGENERATIONFOSTER-FUCHS SPOTSPERIPHERAL RETINAL HOLESMACULAR HOLESCHOROID NEOVASCULARISATION

signsON FUNDUS EXAMINATIONLARGE AND PALE OPTIC DISCTILTED OPTIC NERVE WITH PERIPAPILLARY ATROPHYTEMPORAL MYOPIC CRESCENT/ PERIPAPILLARY CRESCENTTIGROID/BLOND FUNDUSCHORIORETINAL ATROPHYPERIPHERAL VITREOUS DETACHMENTLACQUER CRACKSLATTICE DEGENERATIONCOBBLESTONE DEGENERATIONFOSTER-FUCHS SPOTSPERIPHERAL RETINAL HOLESMACULAR HOLESCHOROID NEOVASCULARISATION

signsON FUNDUS EXAMINATIONLARGE AND PALE OPTIC DISCTILTED OPTIC NERVE WITH PERIPAPILLARY ATROPHYTEMPORAL MYOPIC CRESCENT/ PERIPAPILLARY CRESCENTTIGROID/BLOND FUNDUSCHORIORETINAL ATROPHYPERIPHERAL VITREOUS DETACHMENTLACQUER CRACKSLATTICE DEGENERATIONCOBBLESTONE DEGENERATIONFOSTER-FUCHS SPOTSPERIPHERAL RETINAL HOLESMACULAR HOLESCHOROID NEOVASCULARISATION

signsON FUNDUS EXAMINATIONLARGE AND PALE OPTIC DISCTILTED OPTIC NERVE WITH PERIPAPILLARY ATROPHYTEMPORAL MYOPIC CRESCENT/ PERIPAPILLARY CRESCENTTIGROID/BLOND FUNDUSCHORIORETINAL ATROPHYPOSTERIOR VITREOUS DETACHMENTLACQUER CRACKSLATTICE DEGENERATIONCOBBLESTONE DEGENERATIONFOSTER-FUCHS SPOTSPERIPHERAL RETINAL HOLESMACULAR HOLESCHOROID NEOVASCULARISATION

signsON FUNDUS EXAMINATIONLARGE AND PALE OPTIC DISCTILTED OPTIC NERVE WITH PERIPAPILLARY ATROPHYTEMPORAL MYOPIC CRESCENT/ PERIPAPILLARY CRESCENTTIGROID/BLOND FUNDUSCHORIORETINAL ATROPHYPERIPHERAL VITREOUS DETACHMENTLACQUER CRACKSLATTICE DEGENERATIONCOBBLESTONE DEGENERATIONFOSTER-FUCHS SPOTSPERIPHERAL RETINAL HOLESMACULAR HOLESCHOROID NEOVASCULARISATION

signsON FUNDUS EXAMINATIONLARGE AND PALE OPTIC DISCTILTED OPTIC NERVE WITH PERIPAPILLARY ATROPHYTEMPORAL MYOPIC CRESCENT/ PERIPAPILLARY CRESCENTTIGROID/BLOND FUNDUSCHORIORETINAL ATROPHYPERIPHERAL VITREOUS DETACHMENTLACQUER CRACKSLATTICE DEGENERATIONCOBBLESTONE DEGENERATIONFOSTER-FUCHS SPOTSPERIPHERAL RETINAL HOLESMACULAR HOLESCHOROID NEOVASCULARISATION

signsON FUNDUS EXAMINATIONLARGE AND PALE OPTIC DISCTILTED OPTIC NERVE WITH PERIPAPILLARY ATROPHYTEMPORAL MYOPIC CRESCENT/ PERIPAPILLARY CRESCENTTIGROID/BLOND FUNDUSCHORIORETINAL ATROPHYPERIPHERAL VITREOUS DETACHMENTLACQUER CRACKSLATTICE DEGENERATIONCOBBLESTONE DEGENERATIONFOSTER-FUCHS SPOTSPERIPHERAL RETINAL HOLESMACULAR HOLESCHOROID NEOVASCULARISATION

signsON FUNDUS EXAMINATIONLARGE AND PALE OPTIC DISCTILTED OPTIC NERVE WITH PERIPAPILLARY ATROPHYTEMPORAL MYOPIC CRESCENT/ PERIPAPILLARY CRESCENTTIGROID/BLOND FUNDUSCHORIORETINAL ATROPHYPERIPHERAL VITREOUS DETACHMENTLACQUER CRACKSLATTICE DEGENERATIONCOBBLESTONE DEGENERATIONFOSTER-FUCHS SPOTSPERIPHERAL RETINAL HOLESMACULAR HOLESCHOROID NEOVASCULARISATION

signsON FUNDUS EXAMINATIONLARGE AND PALE OPTIC DISCTILTED OPTIC NERVE WITH PERIPAPILLARY ATROPHYTEMPORAL MYOPIC CRESCENT/ PERIPAPILLARY CRESCENTTIGROID/BLOND FUNDUSCHORIORETINAL ATROPHYPERIPHERAL VITREOUS DETACHMENTLACQUER CRACKSLATTICE DEGENERATIONCOBBLESTONE DEGENERATIONFOSTER-FUCHS SPOTSPERIPHERAL RETINAL HOLESMACULAR HOLESCHOROID NEOVASCULARISATION

signsON FUNDUS EXAMINATIONLARGE AND PALE OPTIC DISCTILTED OPTIC NERVE WITH PERIPAPILLARY ATROPHYTEMPORAL MYOPIC CRESCENT/ PERIPAPILLARY CRESCENTTIGROID/BLOND FUNDUSCHORIORETINAL ATROPHYPERIPHERAL VITREOUS DETACHMENTLACQUER CRACKSLATTICE DEGENERATIONCOBBLESTONE DEGENERATIONFOSTER-FUCHS SPOTSPERIPHERAL RETINAL HOLESMACULAR HOLESCHOROID NEOVASCULARISATION

signsON FUNDUS EXAMINATIONLARGE AND PALE OPTIC DISCTILTED OPTIC NERVE WITH PERIPAPILLARY ATROPHYTEMPORAL MYOPIC CRESCENT/ PERIPAPILLARY CRESCENTTIGROID/BLOND FUNDUSCHORIORETINAL ATROPHYPERIPHERAL VITREOUS DETACHMENTLACQUER CRACKSLATTICE DEGENERATIONCOBBLESTONE DEGENERATIONFOSTER-FUCHS SPOTSPERIPHERAL RETIN