Morphological Characteristics and Risk Factors of Myopic Maculopathy in an Older High Myopia Population—Based on the New Classification System (ATN)

Chen, Qiuying; He, Jiangnan; Hu, Guangyi; Xu, Xiaoyan; Lv, Hanyi; Yao, Yin; Zou, Haidong; Zhu, Jianfeng; Xu, Xun

doi:10.1016/j.ajo.2019.07.010

Cited by 42 publications

(49 citation statements)

References 37 publications

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“…The presence of this elevated tissue within the LMH rendered the floor thicker and may prevent a full-thickness floor defect. One recent study involving maculopathy in high myopia reported that thinner macular choroidal thickness may be associated with myopic atrophic and neovascular maculopathy, but not with MTM [11]. The present data further showed that the baseline subfoveal choroidal thickness failed to predict the development of FD or FTMH.…”

Section: Plos Onecontrasting

confidence: 49%

“…Based on the new grading system [11], the severity of myopic atrophic maculopathy was classified as follows: A0, no myopic retinal lesions; A1, tessellated fundus; A2, diffuse PLOS ONE chorioretinal atrophy; A3, patchy chorioretinal atrophy; and A4, macular atrophy. Eyes with A2 or higher-grade retinal lesions were considered to have myopic atrophic maculopathy.…”

Section: Clinical Characteristics and Oct Parametersmentioning

confidence: 99%

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Clinical characteristics and long-term evolution of lamellar macular hole in high myopia

Hsia

Yang

et al. 2020

PLoS ONE

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To evaluate the clinical characteristics and evolution of lamellar macular hole (LMH) in high myopia and the parameters associated with structural worsening, defined as the development of foveal detachment or full-thickness macular hole. Methods Patients with high myopia and LMH were retrospectively recruited. The clinical characteristics and various parameters of optical coherence tomography were identified at baseline and during follow-up visits. Cox regression analysis was used to evaluate the hazard ratios for foveal detachment and full-thickness macular hole. Results Among 112 eyes (98 patients), 64.3% were female; the mean axial length of all eyes was 29.6 ± 1.9 mm. The 'LMH without retinoschisis' group accounted for 39.3% of the eyes. Forty-two percent developed structural worsening within a median follow-up of 67 months. Multivariable regression on all cases showed elevated tissue inside the LMH (P = 0.003) protected against structural worsening while V-shaped LMH (P = 0.006) predicted it. In the "LMH with retinoschisis group", ellipsoid zone disruption (P = 0.035), and V-shaped LMH (P = 0.014) predicted structural worsening, while elevated tissue inside the LMH (P = 0.028) protected against it. In the "LMH without retinoschisis group", no associated factor was identified. Conclusions LMHs in high myopia are unstable, especially those with V-shaped LMH. Elevated tissue inside LMHs have a protective effect against further structural worsening.

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Section: Plos Onecontrasting

confidence: 49%

Section: Clinical Characteristics and Oct Parametersmentioning

confidence: 99%

Clinical characteristics and long-term evolution of lamellar macular hole in high myopia

Hsia

Yang

et al. 2020

PLoS ONE

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“…And the research of posterior fundus changes in PM also found that LCs often appeared at the early stage of MM, and the young individuals often do not have noticeable staphyloma or early atrophic changes of the retina [20]. However, the ATN system classi ed LCs into the neovascular group, which may lead to the classi cation of someLCs that may develop into patchy atrophy as the neovascular lesion and further impact the validity of this classi cation system in a long-term progress observation [21]. Consequently, further study to determine the standard of LCs identi cation and modi cation of LCs classi cation was necessary and important.…”

Section: Discussionmentioning

confidence: 99%

“…When fundus occurred macular hemorrhage, the T lesion may be affected and frequently misdiagnosed as foveal detachment (T3), and the macular holes with retinal detachment (T5) lesion often affected the fundus photographs quality that leads to grade A stage was di cult to identi ed. Chen and colleagues [21] in the research of the morphological characteristics and risk factors of MM proposed that the coexistence of the three components could in uence the correlation between risk factors and speci c type of MM. Therefore, dissolving the impact of coexistence among the three components, whether in accurative diagnosis or observation of the progression of MM was still a challenge.…”

Section: Discussionmentioning

confidence: 99%

Intra and Inter-observer Concordance of a New Classification System for Myopic Maculopathy

Zhang

Hou

et al. 2020

Preprint

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Background: Myopic maculopathy (MM) is one of the major causes of visual impairment and irreversible blindness in eyes with PM. However, the classification of each type of lesion associated with MM has not been determined. Recently, a new MM classification system was proposed, known as the ATN grading and classification system, which was based on the fundus photographs and OCT images, including three variable components: atrophy (A), traction (T), and neovascularization (N). Hence, this study aimed to perform an independent interobserver and intraobserver agreement evaluation of the recently developed ATN grading system for MM. Methods: This was a retrospective study. Fundus photographs and the optical coherence tomography (OCT) images of 125 patients (226 eyes) with various of MM were evaluated and classified using the ATN grading of the new MM classification system by four evaluators (2 attending ophthalmologists and 2 ophthalmic residents). All cases were repeatedly evaluated by the same evaluators after an interval of 6 weeks. The Kappa coefficient (κ) and 95% confidence interval (CI) were used to determine the interobserver and intraobserver agreement.Results: The interobserver reliability was substantial when considering the maculopathy type (A, T, and N). The weighted Fleiss κ values for each MM type (A, T, and N) were 0.651 (95% CI: 0.602–0.700), 0.734 (95% CI: 0.689–0.779), and 0.702 (95% CI: 0.649–0.755), respectively. The interobserver agreement when considering the sub-types was good or excellent, except for stages A1, A2, and N1 which weighted κ value was less than 0.6, with a moderate agreement. The intraobserver reproducibility of types or sub-types was excellent, with κ>0.8. No significant differences were observed between attending ophthalmologists and residents in the interobserver reliability and intraobserver reproducibility.Conclusions: The ATN classification allows an adequate agreement among ophthalmologists with different qualifications and by the same observer on separate occasions. Future prospective studies should further evaluate whether this classification can be better implemented at clinical decision-making and disease progression assessment.

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“…The choroid is sometimes up to 10 times thinner that in an emmetropic eye [7]. Choroid thickness is a direct risk factor both for developing myopic retinal changes and for developing glaucoma [8,9]. Central and peripheral retinal degeneration in particular contributes to an increased rate of visual impairment and blindness with high myopia [10].…”

Section: Introductionmentioning

confidence: 99%

Bony Orbital Decompression in Patients with High Myopia and Pseudoexophthalmos

Daser

Mattheis

Stähr

et al. 2020

Klin Monbl Augenheilkd

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Introduction High myopic eyes grow in length (> 0.35 mm/dpt) more than in height and width leading to a disturbing unilateral exophthalmos in patients with anisomyopia and – more rarely – a bilateral exophthalmos in high myopia affecting both eyes. Secondary consequences are sicca symptoms and painful eye mobility due to a large bulbus in a too small bony orbit. The aim of the work was to evaluate the effectiveness of bony orbital compression in cases of high myopia. Material and Methods Four patients underwent bony orbital decompression between the years 2012 and 2019. Two of the patients received lateral and two of them balanced (medial endonasal endoscopic and lateral) decompression. The decompression effect, complications and the influence of decompression on eye position and motility were evaluated. Results Significant decompression effect was achieved in all patients. As a result, symmetry was restored in all unilaterally affected patients. No complications occurred. The lateral decompression had a positive effect on the preexisting convergent strabismus (reduction of the “eso” position, neutral to the vertical deviation). The carefully dosed medial decompression did not lead to any change of the horizontal position in one patient and in the other exotropic patient it resulted in a 10 pdpt of “exo” reduction without developing an “eso” position. Discussion The bony orbital decompression provides a sufficient decompression effect in the four patients to reduce the myopic pseudoexophthalmos. The alignment anomalies associated with a high myopia (“heavy eye”) was favourably influenced by the lateral decompression.

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Morphological Characteristics and Risk Factors of Myopic Maculopathy in an Older High Myopia Population—Based on the New Classification System (ATN)

Cited by 42 publications

References 37 publications

Clinical characteristics and long-term evolution of lamellar macular hole in high myopia

Clinical characteristics and long-term evolution of lamellar macular hole in high myopia

Intra and Inter-observer Concordance of a New Classification System for Myopic Maculopathy

Bony Orbital Decompression in Patients with High Myopia and Pseudoexophthalmos

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