Objective To observe the morphological characteristics of high myopia (HM) paravalvular abnormalities (PVA), and the correlation between different manifestations of PVA and myopic traction maculopathy (MTM) was analyzed. MethodsA cross-sectional clinical study. A total of 42 middle-aged and elderly patients with HM and PVA diagnosed by ophthalmology examination in Department of Ophthalmology, The Second Hospital of Hebei Medical University from June to December 2021 were included in the study. There were 24 eyes in 16 males and 48 eyes in 26 females. Age was (56.71±8.10) years old. Diopter was (－13.05±3.10) D. Axial length (AL) was (28.22±1.04) mm. According to the characteristics of ultra-wide-angle optical coherence tomography images, PVA morphology was divided into paravascular microfolds (PM), paravascular cysts (PC) and paravascular lamellar holes (PLH). MTM was divided into T0-T5 grades, of which MTM≥T3 was defined as severe MTM. The state of vitreoretinal junction was observed and the state of posterior vitreous detachment (PVD) was recorded, which divided into complete PVD and partial PVD. Partial PVD was divided into macular fovea adhesions and paravascular adhesions according to the vitreoretinal adhesions. Posterior scleral staphyloma (PS) was divided into 6 types by ultra-wide-angle fundus photography. Logistic regression model was used to analyze the factors related to MTM. ResultsIn 72 eyes, PM, PC and PLH were 72 (100.0%, 72/72), 62 (86.1%, 62/72) and 29 (40.3%, 29/72) eyes, respectively. Among them, there were 10 (13.9%, 10/72) eyes with PM alone, 33 (45.8%, 33/72) eyes with PM and PC, and 29 (40.3%, 29/72) eyes with PM, PC and PLH, respectively. There were 42 eyes with partial PVD (58.3%, 42/72), among which the macular fovea and paravascular adhesion were 22 (52.4%, 22/42) and 24 (57.1%, 24/42) eyes, respectively. PS was present in 50 eyes (69.4%, 50/72), among which 27 (54.0%, 27/50), 21 (42.0%, 21/50), 1 (2.0%, 1/50), and 1 (2.0%, 1/50) eyes were types Ⅰ to Ⅳ, respectively. Multivariate logistic regression analysis showed that AL[odds ratio (OR)=16.139, 95% confidence interval (CI) 4.062-64.120, P＜0.001], PS (OR=4.212, 95%CI 1.234-14.378, P=0.022), paravascular vitreoretinal adhesion (OR=3.478, 95%CI 11.124, P=0.036) were risk factors for PM, PC and PLH. MTM was present in 58 eyes (80.6%, 58/72), among which T1 was the most common type in 19 eyes (26.4%, 19/72). Univariate logistic regression analysis showed that the occurrence of MTM was significantly correlated to PS (OR=4.190, 95%CI 1.240-14.157, P=0.021), coexistence of PM, PC and PLH (OR=11.323, 95%CI 1.389-92.311, P=0.023), and PS were significantly correlated. There was no correlation with PVD (OR=1.889, 95%CI 0.580-6.150, P=0.291) or PS (OR=2.778, 1.786; 95%CI 0.700-11.023; 0.445-7.167; P=0.146, 0.413). There was significant difference in the incidence of severe MTM between PM alone, PM combined with PC and coexistence of PM, PC and PLH (χ2=20.943, P＜0.001). ConclusionsPM is the most common and earliest manifestation of PVA in middle-aged and elderly HM patients. AL, PS and paravascular vitreoretinal adhesion are risk factors for PM, PC and PLH. The coexistence of three PVA forms may be a marker of severe MTM.
Perifoveal exudative vascular anomalous complex (PEVAC) are class of diseases characterized by isolated aneurysmal lesions of the perifovea with hemorrhage and hard exudates, which are found in recent years. Its pathogenesis and pathological process are not yet fully elucidated. The current consensus through multimodal imaging studies is that PEVAC is an idiopathic perifoveal retinal vascular abnormality with cystoid macular edema (CME) and hard exudate. It is not easily distinguished clinically from retinal microaneurysm due to diabetic retinopathy or retinal vein occlusion, aneurysmal telangiectasia, and type 3 macular neovascularization (stage Ⅰ). PEVAC is a partially self-healing property, and some aneurysms and CME may resolve on their own during follow-up period. Laser photocoagulation is an effective measure for the treatment of PEVAC. In the future, with the rapid development of imaging technology, the progress of research on pathogenesis and treatment strategies and the updating of theories are expected to provide more effective treatments for PEVAC.
ObjectiveTo compare the clinical characteristics of primary multiple evanescent white dot syndrome (MEWDS) and secondary MEWDS. MethodsA retrospective case-control study. A total of 27 patients 29 eyes diagnosed with MEWDS at the Eye Center of the Second Hospital of Hebei Medical University from January 2022 to January 2024 were enrolled in this study. All affected eyes underwent best corrected visual acuity (BCVA), fundus color photography, fundus autofluorescence (FAF), ultra-widefield FAF, fluorescein fundus angiography (FFA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT) examinations. Among them, 9 eyes (all primary MEWDS) were examined separately by ultra-wide-angle swept-frequency source OCT angiography (WF SS-OCTA). BCVA was measured using a standard logarithmic visual acuity chart and was converted to the logarithmic minimum angle of resolution (logMAR) visual acuity during statistics. Distribution patterns of MEWDS lesions were categorized into optic disc, macular, and sectoral based on ultra-widefield FAF. Based on whether it was complicated by other chorioretinal diseases or whether other chorioretinal diseases appeared before the resolution of MEWDS lesions, the affected eyes were divided into a primary MEWDS group and a secondary MEWDS group, comprising 14 cases 16 eyes and 13 cases 13 eyes, respectively. Among the 13 eyes in the secondary MEWDS group, 8 were complicated by multifocal choroiditis, 3 by punctate inner choroidopathy, and 2 by idiopathic choroidal neovascularization. The clinical and multimodal imaging features were compared between the two groups. Comparison of two sets of count data was performed using Fisher's exact probability test. ResultsThe mean logMAR BCVA was 0.20±0.17 in the primary MEWDS group and 0.44±0.19 in the secondary MEWDS group. The primary group comprised 10 eyes with the optic disc pattern and 6 with the macular pattern, whereas the secondary group had 2 and 11 eyes, respectively. An intact retinal pigment epithelium (RPE)-Bruch's membrane (BM)-choroidal capillary plexus (CC) complex was observed in 16 eyes and 13 eyes of the primary and secondary groups, respectively. The choroidal thickness was 229.00 (110.75) μm and 250.00 (117.50) μm in the primary and secondary groups, respectively. Statistically significant differences were observed between the two groups in logMAR BCVA (t=-3.64), distribution patterns of MEWDS lesions, and the number of eyes with intact RPE-BM-CC complex (P＜0.05). In contrast, no statistically significant differences were found in choroidal thickness, multimodal imaging features, or inflammatory scores (P＞0.05). WF SS-OCTA was performed in 9 eyes, the superficial capillary plexus, deep capillary plexus, outer retina and choriocapillaris layer appeared normal. En-face OCT at the layer of the outer retina showed hyperreflective dots and spots disseminated at the optic disc and posterior pole, corresponding roughly to spots on color fundus photography, hyperfluorescence in the early phase of FFA, hypofluorescence in the late phase of ICGA, hyperautofluorescence on ultra-widefield FFA and disruption of outer retina in OCT. ConclusionsThe RPE-BM-CC complex in primary MEWDS was intact and predominantly manifested in the optic disc pattern. In secondary MEWDS, the RPE-BM-CC complex was mostly incomplete and predominantly manifested in the macular pattern.
