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