ObjectiveTo compare the efficacy of pars plana vitrectomy (PPV) combined inverted internal limiting membrane (ILM) with PPV combined ILM peeling for macular hole retinal detachment (MHRD) in high myopia.MethodsA retrospective clinical study. From October 2012 to January 2019, 78 patients (78 eyes) with high myopia macular hole retinal detachment diagnosed from Chongqing Aier Eye Hospital and Hefei Aier Eye Hospital were included in the study. Among them, there were 11 males (11 eyes) and 67 females (67 eyes) with the average age of 55.6±9.6 years. All patients underwent BCVA, diopter, OCT examination and axial length (AL) measurement. The standard logarithmic visual acuity chart was used for BCVA examination, and the visual acuity was converted to logMAR when recorded. Patients were divided into PPV combined with ILM peeling group (ILM peeling group) and PPV combined with ILM inverted group (ILM inverted group) according to the surgical method, with 51 patients (51 eyes) and 27 patients (27 eyes), respectively. The average age (t=－1.170), diopter (t=0.504), AL (t=0.474), logMAR BCVA (t=0.935), and hole diameter (t=－0.334) of the two groups were compared, and there was no statistically significant difference (P＞0.05). Two independent sample t test was used to compare the exposed distance of BCVA and RPE before and after the operation of the two groups of eyes. The χ2 test was used to compare the rates between the two groups.ResultsAt the last follow-up, the logMAR BCVA of the eyes in the ILM inverted group and ILM peeling group were 0.87±0.27 and 1.45±0.39, respectively. Compared with pre-operation, the BCVA of the two groups of eyes were significantly improved, and the difference was statistically significant (t=8.790, 4.640, P＜0.001,＜0.001). The logMAR BCVA of the two groups of eyes was compared with statistical significance (t=6.830, P＜0.001). The exposed RPE distances of the eyes in the ILM inverted group and the inner limiting membrane peeling group were 31.81±23.52 and 681.80±466.61 μm, respectively. the difference in the RPE exposure distance between the two groups was statistically significant (t=7.180, P＜0.001). The holes in the 27 eyes in the ILM inverted group were healed (100%, 27/27); no retinal detachment occurred. Among the 51 eyes in the ILM peeling group, the hole healed in 45 eyes (88.2%, 45/51), and the retina was detached in 6 eyes (11.8%, 6/51). There was a statistically significant difference in the incidence of retinal detachment between the two groups of patients (χ2=45.440, P=0.000).ConclusionCompared to ILM peeling, inverted ILM has provided better RPE protection and reduce the rate of retinal redetachment in patients with MHRD.
ObjectiveTo observe the morphological characteristics of dome-shaped macula (DSM) and macular hole (MH) in high myopia by optical coherence tomography (OCT), to further explore the correlation between DSM and MH. MethodsA retrospective case-control study. From April 2021 to December 2023, 963 eyes of 503 patients with high myopia (myopic diopter ≥6.00 D) in Department of Ophthalmology of the Fourth Hospital of Hebei Medical University were enrolled in the study. The age of patients ranged from 5 to 89 years old, with the mean age of (48.91±16.69) years. Diopter was −6.00 to −26.00 (−10.49±3.15) D. All eyes were examined by OCT. The width and height of DSM, subfoveal choroidal thickness (SFCT), inner port diameter and base diameter of MH were measured by software on OCT. According to the OCT image features, DSM was divided into horizontal and vertical oval-shaped DSM, and symmetrical round DSM. According to the presence or absence of DSM, the eyes were divided into DSM group and non-DSM group. Then, the affected eyes with MH were divided into DSM with MH group and non-DSM with MH group. The incidence of DSM, the incidence of MH in the DSM group and the non-DSM group, the inner port diameter of MH, the base diameter of MH, SFCT, and the location of retinoschisis (RS) in the DSM with MH group and the non-DSM with MH group were observed. Independent sample t test or non-parametric Mann-Whitney U test was used for comparison between groups. Pearson correlation analysis was used to analyze the related factors of MH inner port diameter, base diameter and DSM width, height, height/width ratio. ResultsAmong the 963 eyes, the DSM group and the non-DSM group were 266 (27.6%, 266/963) and 697 (72.4%, 697/963) eyes. Compared with the non-DSM group, patients in the DSM group were older (Z=−11.302), had higher degree of myopia (Z=−8.944), thinner SFCT (Z=−16.244), and higher incidence of MH (χ2=8.828), and the differences were statistically significant (P＜0.05). Compared with non-DSM with MH group, the patients in DSM with MH group were older (t=2.610), higher myopia diopter (t=3.593), and thinner SFCT (t=3.505), the differences were statistically significant (P＜0.05). There was no significant difference in the number of eyes in the epiretinal membrane between the two groups (χ2=0.119, P=0.730). In the DSM with MH group, RS mostly occurred in the outer retina with a large range, while in the non-DSM with MH group, RS mostly occurred in the outer and inner retina with a small range. There was a statistically significant difference in the number of eyes at different positions of RS between the two groups (χ2=25.131, P＜0.05). The results of correlation analysis showed that there was no correlation between the inner port and base diameter of MH and the width, height, height/width ratio of DSM (P＞0.05). ConclusionsCompared with high myopia patients without DSM, patients with DSM are older, have more severe myopia and thinner SFCT. In DSM patients with MH, RS often occurs in the outer retina and has a large range. There was no significant association between DSM morphology and MH size.
ObjectiveTo use ultrasound biomicroscope (UBM) to observe the zonules in patients before cataract surgery and study the relation between the length of zonules and axial length (AL), so as to understand the underlying anatomical and pathological basis of factors influencing the stability of lens capsule in high axial myopic patients and provide objective theoretical references for surgical risk reduction and postoperative follow-up guidance. MethodsFifty-five patients (55 eyes) proposed to receive phacoemulsification between October 2014 and October 2015 were divided into group A (AL < 26 mm, n=21), group B (26 mm≤AL < 29 mm, n=14), and group C (AL≥29 mm, n=20) according to their AL.UBM examination was conducted preoperatively.Through measuring the length of zonules in supine position at 12, 3, 6, and 9 o'clock respectively, we compared the difference of the length of zonules among those three groups, and explored the correlation between the length of zonules and axial length. ResultsThe average length of zonules in group A was (0.67±0.13) mm, while that in group B and group C was (0.93±0.29) and (0.98±0.19) mm, respectively.The length of zonules in group A was shorter than that in group B and Group C, and the differences were statistically significant (P < 0.001);and that in group B was shorter than that in group C, but the difference was of no statistical significance (P=0.331).In the correlation analysis between axial length and the average length of zonules, the length of zonules was positively correlated with the axial length (r=0.502). ConclusionsUBM provides a quantitative method for observing zonules.In the assessment before cataract surgery, it is a more accurate method for evaluation of zonules, and probably has a certain value in pre-assessment of intra ocular lens dislocation after cataract surgery.
Objective To explore the influencing factors of intraocular lens (IOL) position after cataract surgery and analyze the effect of ocular biological parameters on IOL centering under different axial length (AL). Methods Patients who underwent cataract phacoemulsification and IOL implantation at West China Hospital of Sichuan University between February and July 2024 were prospectively selected. According to the different AL values, the patients were divided into non-high myopia group (22.0 mm≤AL＜26.0 mm) and high myopia group (AL≥26.0 mm) to explore the influencing factors of IOL position after cataract surgery. Results This study included a total of 240 patients (240 eyes), with 120 cases (120 eyes) in both the non-high myopia group and the high myopia group. The preoperative lens tilt and decentration of the non-high myopia group and high myopia group were (4.41±1.07)°, (0.13±0.09) mm and (3.57±1.81)°, (0.20±0.10) mm, respectively. The results of multiple linear regression analysis showed that in the non-high myopia group, preoperative lens tilt (P<0.001) was the influencing factor of postoperative IOL tilt, while lens thickness (P=0.027) and preoperative lens decentration (P<0.001) were the influencing factors of postoperative IOL decentration. In the high myopia group, lens thickness (P=0.023) and preoperative lens tilt (P<0.001) were the influencing factors of postoperative IOL tilt, while anterior chamber depth (P=0.030), lens thickness (P=0.013), and preoperative lens decentration (P<0.001) were the influencing factors of postoperative IOL decentration. Conclusion Ophthalmologists can accurately predict the postoperative IOL position based on the patient’s degree of myopia (with a focus on identifying high myopia) and specific ocular biological parameters before surgery, thereby optimizing surgical plans and improving postoperative outcomes.
Objective To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and C3F8 tamponade for patients with highly myopic macular hole (HM-MH) with and without foveoschisis. MethodsA retrospective case controlled study. From January 2017 to February 2022, 23 eyes of 23 patients with highly myopic macular hole with and without foveoschisis diagnosed in the Shandong Eye Hospital were included in the study. Among them, 5 males had 5 eyes, and 18 females had 18 eyes, the age was (54.43±12.96) years old. The patients with or without foveoschisis were 12 eyes in 12 cases and 11 eyes in 11 cases. Studies were divided into two groups, depending on the presence of a concomitant myopic foveoschisis or not. The groups are high myopia macular hole with foveoschisis (group A) and high myopia macular hole without foveoschisis (group B). Best-corrected visual acuity (BCVA), B-scan ultrasonography, optical coherence tomography and axial length (AL) measurement were performed in all eyes. Snellen chart was used for BCVA examination, and the visual acuity was converted into logarithm of minimum angle of resolution (logMAR) during statistics. The age of the two groups, sex, macular hole (MH) diameter, logMAR BCVA, AL, posterior scleral staphyloma, there was no significant difference (P＞0.05). PPV combined with ILM peeling and C3F8 filling were performed in all eyes. Follow-up was at least 3 months after the last operation. BCVA changes and MH closure were compared between the two groups after surgery. Wilcoxon test was used to compare BCVA before and after operation. Mann-whiteny U test was used to compare preoperative and postoperative BCVA between groups. ResultsAfter initial surgery, MH was closed in 17 of 23 eyes (74%, 17/23). MH was closed in 8 eyes in group A (66.7%, 8/12). Four eyes were not closed (33.3%, 4/12); MH closed in 9 eyes in group B (81.8%, 9/11). There was no significant difference between the two groups after initial operation (P＞0.05). At 1 and 3 months after surgery, the logMAR BCVA of patients in group A and group B were 1.00±0.46, 1.03±0.83 and 0.53±0.63, 0.55±0.41, respectively. Compared with before operation, there was no significant difference at 1 month (P=0.783, 0.358), but the difference was statistically significant at 3 months (P=0.012, 0.007). There was no significant difference in logMAR BCVA between group A and group B at 1 and 3 months after operation (P=0.687, 0.950). ConclusionPPV combined with ILM peeling and C3F8 tamponade can promote MH closure and improve visual acuity in most affected eyes with HM-MH with and without foveoschisis.
ObjectiveTo observe and analyze the superficial retinal blood flow density and its related influencing factors in the macular area of adolescents with different types of non-pathological high myopia (HM). MethodsA retrospective clinical study. From March to August 2022, 117 eyes of 117 adolescents who were admitted to Liaocheng Aier Eye Hospital due to myopia were included in the study. According to equivalent spherical degree (SE) and corneal curvature, subjects were divided into mild myopia or emmetropia group (control group), HM group, occult HM (OHM) group, and super HM (SHM) group, with 30 eyes, 28 eyes, 35 eyes, and 24 eyes, respectively. All subjects underwent medical optometry, intraocular pressure, optical coherence tomography (OCT), OCT angiography (OCTA), axial length (AL) and corneal curvature measurements. The diopter was SE. OCTA instrument was used to scan the macular region in the range of 6 mm×6 mm, and the software automatically divided it into three concentric circles centered on the fovea of the macular, namely, the central area with a diameter of 1 mm, the inner ring area with a diameter of 1-3 mm, and the outer ring area with a diameter of 3-6 mm. The superficial retinal vascular density (SRVD), vascular perfusion density (SBPD), the area, perimeter (PERIM), avascular index (AI) of foveal avascular area (FAZ) and retinal thickness were measured in the macular region as a whole and in different regions. One-way analysis of variance was used to compare the data among groups, and the least significant difference t-test was used to compare the data among groups. The correlation of AL, corneal curvature and intraocular pressure with SRVD and SBPD in macula was analyzed by Pearson correlation analysis. ResultsThere were significant differences in SRVD and SBPD in the central, inner and outer regions of macula in control group, HM group, OHM group and SHM group (P＜0.05). There were statistically significant differences in the thickness of the retina above, below and on the temporal side of the central and outer ring regions (P＜0.05). However, no statistically significant difference was in the thickness of the retina on the nasal side (P＞0.05). There was no significant difference in PERIM (P＞0.05). There were significant differences in FAZ area and AI (P＜0.05). Correlation analysis showed that AL was negatively correlated with SRVD and SBPD in macular whole and central, inner and outer ring regions (P＜0.05). Corneal curvature and SE were positively correlated with the SRVD and SBPD of macular whole, central area and outer ring area (P＜0.05). AL was negatively correlated with retinal thickness in the outer ring region (P＜0.05). SE was positively correlated with the thickness of the retina above, below and temporally in the outer ring region (P＜0.05). AL was negatively correlated with FAZ area and AI (P＜0.05). SE was positively correlated with FAZ area and PERIM (P＜0.05). Retinal thickness was positively correlated with SRVD and SBPD (P＜0.05). ConclusionsThe SRVD and SBPD of different types of HM in adolescents decreases to different degrees. The thickness of the retina in the central region is thicker, and the retina in the outer ring region is thinner. With the decrease of SRVD, the retinal thickness gradually is thinner.
ObjectiveTo investigate the relationship between single nucleotide polymorphisms (SNP) in the CHRM1 gene and genetic susceptibility to high myopia (HM) in the Han population of Henan Province. MethodsA retrospective case-control study. From January 2021 to April 2023, 576 HM patients (HM group) and 768 healthy volunteers (control group) were recruited from the Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University. All participants were of Han ethnicity from Henan Province. SNP data for the CHRM1 gene in the Northern Han Chinese population were downloaded from the 1000 Genomes Project Online Website, with screening criteria of Hardy-Weinberg equilibrium P＞0.05 and minor allele frequency＞0.05. Haploview software was used to analyze HapMap genotypes, identifying 5 tagSNP: rs55885673, rs544978, rs56995061, rs1942499, and rs2075748. MassARRAY system was employed for genotyping the 5 tagSNP loci. The SHEsis online software was employed to analyze the distribution differences of genotypes and allele frequencies between the two groups. Linkage disequilibrium coefficient D' was used to evaluate the recombination events between SNP loci, and haplotypes with frequencies exceeding 3% were constructed for statistical analysis. Results The age of the HM group was significantly lower than that of the control group (t=18.515, P＜0.05), while no significant difference was observed in gender distribution (χ2=2.869, P=0.087). Compared with the control group, the HM group showed significantly higher frequencies of the C allele [odds ratio (OR)=1.44, 95% confidence interval (CI): 1.09-1.91, Pc=0.045)] and CC genotype (OR=1.50, 95%CI: 1.11-2.02, Pc=0.038) at the rs56995061 locus, and significantly lower frequencies of the T allele (OR=0.69, 95%CI: 0.52-0.91, Pc=0.045) and CT genotype (OR=0.67, 95%CI: 0.49-0.91, Pc=0.045). Additionally, the CT genotype frequency at the rs2075748 locus was significantly lower in the HM group (OR=0.66, 95%CI: 0.53-0.84, Pc=0.002). The haplotype G-T-A-A formed by rs55885673-rs56995061-rs1942499-rs544978 was significantly less frequent in the HM group (OR=0.71, 95%CI: 0.54-0.94, P=0.170).ConclusionsThe polymorphisms at the SNP loci rs56995061 and rs2075748 in the CHRM1 gene are associated with the genetic susceptibility to high myopia in the Chinese Han population. The G-T-A-A haplotype composed of rs55885673-rs56995061-rs1942499-rs544978 reduces the susceptibility to high myopia.
High myopia has a high genetic tendency, it not only shows in the excessive elongation of the axial length, but also lends to the formation and progression of various eye lesions, such as peripheral retinopathy, optic disc changes, posterior staphyloma, and myopic maculopathy, due to the mechanical stretching of the axial length to the ocular structure. In addition, high myopia increases the risk of several complications, such as glaucoma, cataract, and corneal disease. All these pathological changes will affect visual function and lead to irreversible vision impairment and blindness in the future. Therefore, it is important to pay attention to screening for optic disc abnormalities and posterior staphyloma, and regular monitor the changes of fundus, intraocular pressure, and lens. At the same time, high myopia has an impact on personal life such as study, psychology, sport, and work, and can reduce the quality of life as well as increase the cost of health care. The clinic should pay more attention to high myopia, prevent and control the development of high myopia from an early stage, in order to minimize its impact on ocular structure and visual function as well as its hazard to personal life and society.
ObjectiveTo investigate the risk factors of high intraocular pressure (IOP) after femtosecond laser in situ keratomileusis (FS-LASIK) in patients with high myopia, and construct and verify nomogram model. MethodsA retrospective clinical study. From January 2019 to January 2021, 327 patients (654 eyes) with high myopia treated with FS-LASIK in the Department of Ophthalmology of the 910th Hospital of the People's Liberation Army Coalition Security Force were included in the study. The patients were categorized into high IOP group and non-high IOP group according to whether high IOP occurred after surgery, which were 60 cases and 120 eyes (18.35%, 60/327) and 267 cases and 534 eyes (81.65%, 267/327), respectively. The clinical data of patients in the two groups were analyzed and observed, and the indicators with differences were subjected to one-way and multifactorial logistic regression analyses, and the results of the regression analyses were visualized to obtain the column line graphs using R3.5.3 software, and the accuracy of the column line graphs was verified by the consistency index (C-index), the calibration curves, and the subject's work characteristic curves (ROC curves). ResultsComparison of the number of cases of affected corneal thickness (χ2=7.424), corneal curvature (χ2=9.849), glucocorticoid treatment (χ2=7.222), intraoperative IOP fluctuation (χ2=11.475), corneal hysteresis (χ2=6.368), and the incidence of intraoperative complications (χ2=6.673) in the hypertensive IOP group and the nonvisualized IOP group were statistically significant (P＜0.05). Binary logistic regression analysis showed that corneal thickness ＞450 μm, corneal curvature≤38 D, glucocorticoid treatment, intraoperative IOP fluctuation, corneal hysteresis ≤8.0 mm Hg (1 mm Hg=0.133 kPa), and intraoperative complications were the risk factors for the occurrence of high IOP after FS-LASIK surgery in patients with high myopia (P＜0.05). The C-index of the column-line graph prediction model based on this was 0.722 (95% confidence interval 0.684-0.760), the calibration curve and the ideal curve were basically the same, and the area under the ROC curve was 0.709. ConclusionsCorneal thickness＞450 μm, keratometric curvature ≤38 D, glucocorticoid treatment, intraoperative fluctuation of intraocular pressure, and corneal hysteresis ≤8.0 mm Hg are the risk factors for the development of hyperopic IOP in highly risk factors for the development of high IOP after FS-LASIK surgery in myopic patients. The column-line diagram model constructed on the basis of the risk factors hava good accuracy.