Pathological Myopia

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PATHOLOGICAL MYOPIA A.JAYA KRISHNA 7 TH SEMESTER

Transcript of Pathological Myopia

Page 1: Pathological Myopia

PATHOLOGICAL MYOPIA

A.JAYA KRISHNA

7TH SEMESTER

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HISTORY OF PATHOLOGICAL MYOPIA

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HISTORY OF PATHOLOGICAL MYOPIA• Myopia- was derived from the original Greek word

“mŭopia” … contracting or closing the eye.

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HISTORY OF PATHOLOGICAL MYOPIA• Myopia- was derived from the original Greek word

“mŭopia” … contracting or closing the eye.• Galen was the first to use the term “MYOPIA”

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HISTORY OF PATHOLOGICAL MYOPIA• Myopia- was derived from the original Greek word

“mŭopia” … contracting or closing the eye.• Galen was the first to use the term “MYOPIA”• Antonio Scarpa (1801) First anatomical

description of posterior staphyloma, but did not make the link to myopia

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HISTORY OF PATHOLOGICAL MYOPIA• Myopia- was derived from the original Greek word

“mŭopia” … contracting or closing the eye.• Galen was the first to use the term “MYOPIA”• Antonio Scarpa (1801) First anatomical

description of posterior staphyloma, but did not make the link to myopia

• Carl Ferdinand von Arlt (1856) First connected staphyloma and myopic refraction

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HISTORY OF PATHOLOGICAL MYOPIA• Myopia- was derived from the original Greek word

“mŭopia” … contracting or closing the eye.• Galen was the first to use the term “MYOPIA”• Antonio Scarpa (1801) First anatomical

description of posterior staphyloma, but did not make the link to myopia

• Carl Ferdinand von Arlt (1856) First connected staphyloma and myopic refraction

• Brian J. Curtin(1977) Classification scheme for staphyloma

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HISTORY OF PATHOLOGICAL MYOPIA• Myopia- was derived from the original Greek word

“mŭopia” … contracting or closing the eye.• Galen was the first to use the term “MYOPIA”• Antonio Scarpa (1801) First anatomical

description of posterior staphyloma, but did not make the link to myopia

• Carl Ferdinand von Arlt (1856) First connected staphyloma and myopic refraction

• Brian J. Curtin(1977) Classification scheme for staphyloma

• Takashi Tokoro(1988) …Definition of pathologic myopia

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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.

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SYNONYMS•DEGENERATIVE MYOPIA•PROGRESSIVE MYOPIA •MALIGNANT MYOPIA•HIGH DEGREE MYOPIA•MAGNA MYOPIA

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PREVALENCE OF PATHOLOGICAL MYOPIACountry % Country %

Myopia

Some Asian countries 70–90% Industrialized -West 10%–25%

Taiwan 84% Africa 10–20%

Industrialized - East 60%–80% India 6.9%

Europe and the US 30–40%

Pathological

Myopia

Asian Countries 9–21% Most countries 1–4% Spain 9.6% USA 2%

Singapore 9.1% Bangladeshi 1.8%Japan 8% Czechoslovakia 1%

Northern China 4.1% Egypt 0.2%

High myopia affects 27%-33% of all myopic eyes in Asia.

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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.

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ETIOLOGY OF PATHOLOGICAL MYOPIA• The 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.

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ROLE OF HEREDITYIt is now confirmed that genetic factors play a major role in the etiology

Stretching of sclera

More growth of

retina

Genetic Factors & General growth factors

It 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 length

Degeneration of choroid

Degeneration of RetinaDegeneration of vitreous

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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 Myopia

MYP1MYP13

AR High Myopia

MYP18

AD High Myopia

MYP2MYP3MYP4MYP5MYP11MYP12MYP15MYP16MYP17MYP19

Common Myopia

MYP7MYP8MYP9MYP10MYP14MYP17

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

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SIGNS• PROMINENT EYE BALLS

• CORNEA IS LARGE

• ANTERIOR CHAMBER IS DEEP

• LARGE AND SLUGGISH PUPILS

• VISUAL FIELD CONTRACTION

• ERG MAY BE SUBNORMAL DUE TO CHORIORETINAL ATTROPHY

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

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

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

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

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

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

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

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

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

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

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

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

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

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COMPLICATIONSRETINAL DETACHMENTCOMPLICATED CATARACTVITREOUS &CHORIDAL HAEMORRHAGESTRABISMUS FIXUS CONVERGENCENORMOTENSIVE GLAUCOMAMYOPIC FOVEOSCHISISPOSTERIOR STAPHYLOMA

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TREATMENT

OPTICAL TREATMEN

T

SURGICAL TREATMEN

T

GENERAL MEASURE

S

LOW VISION AIDS

GENETIC COUNSELLING(PROPHYLAXIS

)

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OPTICAL TREATMENT

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SURGICAL TREATMENTLASER IN-SITU

KERATOMILEUSIS (LASIK)A FLAP OF 130-160 MICRONS THICKNESS OF ANT. CORNEAL TISSUE IS RAISED WITH MICROKERATOME .AFTER THAT THE MID STROMAL TISSUE IS ABLATED WITH EXCIMER LASER BEAM, LEADING TO FLATTENING OF CORNEA .ADVANCES- C-LASIK , E-LASIK .

REFRACTIVE LENS EXCHANGE

CLEAR CRYSTALLINE LENS IS EXTRACTED IS EXTRACTED(FUCALA’S OPERATION) AND IOL OF APPROPRIATE POWER IS IMPLANTED; THAT IS REFRACTIVE LENS EXCHANGE ( RLE ) FOR MYOPIA OF MORE THAN -12D .

PHAKIC REFRACTIVE LENS

ALSO CALLED AS “IMPLANTABLE CONTACT LENS”.A SPECIAL TYPE OF IOL IS PLACED IN ANTERIOR CHAMBER OR POSTERIOR CHAMBER, ANTERIOR TO NATURAL CRYSTALLINE LENS .FOR MYOPIA OF MORE THAN -8D .

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LOW VISION AIDS

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