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Clinicians can benefit from developing an understanding of the natural disease progression of myopic maculopathy in degenerative myopia using optical coherence tomography (OCT).The prevalence of high myopia is constantly increasing. In this work, infrared imaging and OCT is used to study the natural course of the disease.This is a retrospective longitudinal study. Medical records of 72 patients with high myopia (6.00 D) and a minimum five-year follow-up period were analysed. Collected data on all enrolled patients included demographic characteristics and medical history, as well as recordings on best-corrected visual acuity, slitlamp examination, OCT, and fluorescein angiography in cases of suspected myopic choroidal neovascularisation. Images were independently marked by two graders.The mean age of patients was 54.6 ± 14.4 years (59.72% female) with baseline logMAR best-corrected visual acuity of 0.22 ± 0.28. At baseline examination, 70.83% of the study group showed signs of maculopathy and 62.5% diffuse or patchy atrophy. During follow-up, 22.2% of patients with any type of atrophy showed enlarged affected areas. Two patients with baseline lacquer cracks developed new lesions. There was a weak correlation between patient age and maculopathy progression (r = 0.233; p = 0.03). While central retinal thickness was not associated with maculopathy progression (p = 0.203), a moderate correlation was found between choroidal thickness and maculopathy progression (r = -0.516; p 0.001).Lesion characteristics in myopic degeneration have been elucidated, taking advantage of the ongoing technological advances in retinal imaging. The understanding of disease patterns and progression is essential for appropriate management of patients, while discovering biomarkers which lead to choroidal neovascularisation development is of urgent importance to establish international diagnostic criteria and treatment protocols.

To study the retinal capillary microvasculature and the choriocapillaris (CC) in myopic eyes using swept-source optical coherence tomography angiography (SS-OCTA). Patients with high myopia (≥ − 6D; axial length ≥ 26.5 mm), moderate myopia (≥ − 3D, 0.05). The VLDs of the SCP were lower in the high and moderate myopia groups compared with the control group (p 0.05). The retinal microvasculature may demonstrate alterations in highly myopia eyes. The CC in macular regions shows greater impairment in eyes with high myopia compared with eyes with lesser degrees of myopia, and these deficits are already present in the absence of features of pathologic or degenerative myopia. The threshold of CC FD leading to myopic maculopathy remains to be defined.

Macular hole is characterized by a full-thickness defect of the retinal layers in the center of the fovea and is an important cause of central vision loss. Spontaneous closure of a macular hole is rare, most often occurring in traumatic and idiopathic macular holes. In this case report, we present a 51-year-old woman with a myopic macular hole that closed spontaneously. The patient had degenerative myopia and a history of clear lens surgery and multiple laser retinopexy procedures due to retinal tear in both eyes. A macular hole was detected in her right eye, but she declined surgery and was followed up. At 66 months after presentation, bridge formation and spontaneous closure of the macular hole were observed. Spontaneous closure is extremely rare in cases of myopic macular hole, but may be seen in patients who are followed for a long time.

Pathological myopia is a severe case of myopia, i.e., nearsightedness. Pathological myopia is also known as degenerative myopia because it ultimately leads to blindness. In pathological myopia, certain myopia-specific pathologies occur at the eye’s posterior i.e., Foster-Fuchs’s spot, Cystoid degeneration, Liquefaction, Macular degeneration, Vitreous opacities, Weiss’s reflex, Posterior staphyloma, etc. This research is aimed at developing a machine learning (ML) approach for the automatic detection of pathological myopia based on fundus images. A deep learning technique of convolutional neural network (CNN) is employed for this purpose. A CNN model is developed in Spyder. The fundus images are first preprocessed. The preprocessed images are then fed to the designed CNN model. The CNN model automatically extracts the features from the input images and classifies the images i.e., normal image or pathological myopia. The best performing CNN model achieved an AUC score of 0.9845. The best validation loss obtained is 0.1457. The results show that the model can be successfully employed to detect pathological myopia from the fundus images.

Presented of own long-term experience and the generalized results of the researches devoted to use of domestic drugs of peptide structure in complex therapy of a number of diseases of an optic nerve and a retina at patients of children's age. Clinical efficiency of a retinalamin as retinoprotector and cortexin as neuroprotector in treatment and rehabilitation the disabling diseases shown: atrophy of the optic nerve, retinopathy of prematurity and degenerative myopia.

Background We report a case of macular hole (MH) formation and retinal detachment after intravitreal conbercept injection for the treatment of choroidal neovascularization (CNV) secondary to degenerative myopia. Case presentation A 60-year-old woman presented with blurred vision in her left eye was diagnosed as CNV secondary to degenerative myopia. Intravitreal injection of conbercept, an anti -vascular endothelial growth factor (VEGF) agent, was uneventfully performed in the left eye. Unfortunately, a full thickness MH and retinal detachment was found three weeks postoperatively by ophthalmoscopy and spectral-domain optical coherence tomography. Vitrectomy, internal limiting membrane peeling and silicone oil tamponade were then performed, and macular retina was reattached soon after surgery. However, MH still kept open during three months’ follow-up. Conclusion MH is a quite rare complication of intravitreal anti- VEGF agent injection, tangential contraction secondary to CNV shrinkage and regression caused by anti-VEGF agent is proposed to be the major pathogenesis of MH formation.

Purpose. Morphological and functional evaluation of results of intravitreal injections of ranibizumab in treatment of choroidal neovascularization (CNV) caused by degenerative myopia (DM). patients and methods. The study included 32 patients (32 eyes) aged from 29 to 55 years with the CNV, developed due to the DM. They received 0.5 mg (0.05 ml) ranibizumab according to the standard. Indications for repeat intravitreal injections of ranibizumab were retention of the CNV activity or its recurrence. In addition to the standard ophthalmologic examination all patients were examined with fluorescein angiography (FAG) with photodetection of fundus picture and optical coherence tomography (OCT) of the retina (sizing subretinal neovascular membrane (SNM), evaluation of retinal foveal thickness (FCS). The study was conducted before the introduction of ranibizumab, monthly during the first 6 months after surgery, and then, in the absence of symptoms of CNV activity, every 2-3 months. The total follow-up was 12 months. results. the transition the CNV in inactive form according to FAG was observed in 25 people (78.1%) was observed after 1 month (single injection of ranibizumab). The angiographic signs of CNV activity remained after the first injection in 7 patients (21/9%). They received second intravitreal injection of ranibizumab. After 3 months from the beginning of observation according to FAG and OCT data relapse of activity of myopic CNV occurred in 5 patients (15.6%) after a single injection, and in 2 patients (6.3%) — after a double injection of ranibizumab. After 6 months according to FAG disappearance of pathological leakage of the dye was diagnosed in 87.5% of patients (28 eyes). After 12 months follow-up all 32 patients had remission of the pathological process with no evidence of CNV activity with formation of local subretinal fibrosis with choriocapillaries atrophy. Conclusions. It took from 1 to 3 (average 1.58) injections of ranibizumab to transfer the active phase of the CNV in inactive. Complete inhibition of the growth and activity of myopic CNV was accompanied by positive morphological and functional results, which led to a significant improvement in visual acuity in 2 times at the observation period of 12 months.

Purpose. Our aim was to evaluate the ultrasound (US) elastography of ocular and periocular structures in high myopia. Methods. There were 20 eyes of 20 high myopic patients in the study group, whereas there were 20 eyes of 20 age- and sexmatched healthy participants in the control group. The eyes in the study group had myopia greater than j5.0 diopters and had axial length (AL) greater than 25.0 mm. The US elastography measurements were performed with the LOGl ? Q E9 Ultrasound Elastography. The elastography values of anterior vitreous, posterior vitreous (PV), retina-choroid-sclera complex (RCS), and retrobulbar fat tissue (RF) were measured in each eye. Results. Anterior vitreous US elastography values were similar in both groups (p = 0.17), whereas PV is more elastic in high myopic eyes (p = 0.01). There was a moderate negative correlation between AL and RCS/RF elastography ratio (r = j0.35, p = 0.03) and a positive correlation between refractive error and RCS/RF elastography ratio (r = 0.36, p = 0.02). Conclusions. High myopia is associated with more elastic PV. Elasticity of posterior RCS increases as the AL increases. © 2015 American Academy of Optometry.

Pathologic myopia is associated with degenerative changes of the globe, especially at the posterior pole. Eyes affected by pathologic myopia have higher odds to undergo posterior segment surgery and, in those eyes, vitreoretinal surgery is challenging. Many practical tips and tricks can make the surgical procedures simpler, significantly preventing sight-threatening intra- and post-operative complications. Moreover, novel surgical techniques and technological advancements (i.e. ad-hoc instrumentation, minimally invasive vitreoretinal surgery, filters, dye staining, intraoperative optical coherence tomography and 3-dimensional surgery) may play role in highly myopic eyes. The aim of the present work is to review practical tips and tricks, novel surgical techniques and technological advancements. Electronic supplementary material The online version of this article (doi:10.1186/s40942-017-0090-y) contains supplementary material, which is available to authorized users.

Purpose To evaluate visual acuity changes over 3 years following surgical reattachment of macular hole retinal detachment (MHRD) developed in high myopia. Methods A retrospective analysis was performed using the medical records of patients with highly myopic eyes who underwent pars plana vitrectomy with internal limiting membrane peeling or the internal limiting membrane flap technique for MHRD. Changes in best-corrected visual acuity (BCVA) were measured at baseline, 6 months, 1 year, 2 years, and 3 years. Results Of the 22 eyes analyzed, macular hole was closed in 13 and unclosed in nine. BCVA significantly improved from 1.61 ± 0.39 logarithm of the minimum angle of resolution (logMAR) at baseline to 1.17 ± 0.43 logMAR at 6 months and 1.33 ± 0.48 logMAR at 2 years after MHRD surgery. At 3 years, BCVA significantly decreased compared with that at 6 months, and visual improvement from baseline was not significant. BCVA and proportion of vision loss ≥0.3 logMAR were not different between the closed and unclosed macular hole groups. Conclusions Visual improvement after surgical reattachment of MHRD in high myopia was not maintained, and favorable macular hole closure effects were not observed at 3-year follow-up.

La miopía degenerativa constituye una de las causas fundamentales de pérdida de la visión. Esto está relacionado con las alteraciones del polo posterior, que afectan la retina neurosensorial, el epitelio pigmentario de la retina y las capas más internas de la coroides. Su curso lento y progresivo demanda una exploración integral, con seguimiento en el tiempo y constituye un reto para el oftalmólogo. Se realizó una revisión de artículos publicados e indexados en la base de datos de PubMed que se refirieran a las características clínicas del fondo de ojo en pacientes con miopía degenerativa, para describir las principales alteraciones del polo posterior del globo ocular en esta entidad. Se encontró entre las lesiones típicas de la alta miopía, al estafiloma posterior como un signo patognomónico de la enfermedad, asociado a la atrofia coriorretiniana en parches o difusa, así como las estrías de laca y las hemorragias maculares secundarias a ellas o provenientes de membranas neovasculares coroideas. La tomografía de coherencia óptica ha permitido un diagnóstico más preciso de otras lesiones maculares como la foveosquisis, el agujero macular y, más recientemente, la mácula en domo. Los cambios degenerativos del polo posterior parecen guardar relación unos con otros pero la patogenia no ha sido bien esclarecida a pesar de los avances tecnológicos.Degenerative myopia is one of the main causes of visual impairment. This is related to disorders in the posterior pole, affecting the neurosensorial retina, the retinal pigmented epithelium and the inner choroidal layers. The slow and progressive course of this condition demands comprehensive assessment and long follow-up, which is a challenging task for ophthalmologists. A review of the articles indexed in PubMed regarding the clinical characteristics of the fundus in patients with degenerative myopia was made to describe the main disorders of the posterior pole of the eyeball. Posterior staphyloma was found among the typical lesions of high myopia, associated with patchy or diffuse chorioretinal atrophy, lacker cracks, choroidal neovascular membranes and macular hemorrhages secondary to them or stemmed from choroidal neovascular membranes. More accurate diagnosis of foveoschisis, macular holes, and more recently dome-shaped macula has been achieved with optical coherence tomography. The degenerative changes of posterior pole seem to be associated each other, but pathogenesis of myopic retinopathy has not been clearly stated, despite the recent technological advances.

This is a clinicopathological paper on the histologic findings in myopia-associated macular foveoschisis. The findings on ophthalmic pathological study of a 73-year-old woman with high myopia are reviewed. Multiple retinoschisis cavities involving both the macula and retinal periphery were disclosed. Our paper offers tissue evidence and supports recent ocular coherence tomography reports of eyes with high myopia and associated macular foveoschisis.

To evaluate anti-VEGF and photodynamic therapy (PDT) for juxtafoveal and extrafoveal choroidal neovascularization (CNV) due to age-related macular degeneration (ARMD), ocular histoplasmosis syndrome (OHS), and degenerative myopia.A total of 10 eyes with juxtafoveal or extrafoveal choroidal neovascularization underwent intravitreal anti-VEGF therapy combined with verteporfin PDT (689 nm). Most treatments consisted of PDT every 12 weeks and either ranibizumab 0.5 mg every 4 weeks or bevacizumab 1.25 mg every 6 weeks, initiated concurrently. Retreatment criteria were persistent exudative signs on optical coherence tomography or fluorescein angiography.Presenting visual acuity (VA) ranged from 20/20 to 20/60 (mean log MAR+/-SD, 0.338+/-0.16 (20/44 equivalent)). After a mean follow-up of 17.5 months, it ranged from 20/15 to 20/40 (mean log MAR+/-SD, 0.150+/-0.14 (20/28 equivalent); P=0.027, paired t-test). Six eyes improved byor = 2 lines and four remained within 2 lines of initial VA. Non-ARMD eyes required much fewer treatments than ARMD eyes. All five non-ARMD eyes and three of five ARMD eyes showed no CNV activity at least 5 months after last treatment.Anti-VEGF therapy and PDT can preserve good visual function and may be suited to some cases of nonfoveal CNV. ARMD eyes require longer courses of treatment than non-ARMD eyes.

Introduction: The purpose of the study was to evaluate selected visual parameters in the group of patients undergoing long-term treatment with trimetazidine as an adjuvant therapy for primary open angle glaucoma and degenerative myopia.Material and methods: Thirty patients, including 20 patients with advanced primary open angle glaucoma (40 eyes) and 10 patients with severe degenerative myopia (20 eyes), were treated with trimetazidine 20 mg twice a day. We excluded from the study patients with: systemic hypertension and/or diabetes, cataract, history of chronic and recurrent severe inflammatory eye disease and smokers. Patients with primary open angle glaucoma were taking various ocular hypotensive drops topically. Ophthalmic examination has been performed before administration of trimetazidine and then every month. Visual acuity, contrast sensitivity test (Pelli-Robson test), glare test, color vision (Farnsworth-Munsell test) and visual field were recorded. Follow-up period was 6 months. For statistical analysis paired Student’s t- test (p

Purpose: The aim of this study was to compare the thickness of preocular tear film, corneal layers, and anterior sclera in patients with moderate to high myopia and emmetropia with anterior segment spectral domain optical coherence tomography. Methods: This cross-sectional comparative study included 31 patients with high myopia and 31 emmetropic healthy controls. Patients with myopia had axial lengths ranging from 24 to 29 mm, whereas age-matched controls had axial lengths from 21 to 23.9 mm. Patients with myopia had refractive errors from 24.00 to 211.00 diopters spherical equivalent. Preocular tear film, corneal epithelium, Bowman layer, stroma, and Descemet membrane-endothelium complex were measured in the central cornea. Anterior scleral measurements were made at distances of 1, 3, and 5 mm from the limbus. Corneal-scleral thickness was measured with the anterior segment module of spectral domain optical coherence tomography. Results: No statistically significant differences (P > 0.05) between patients with myopia and controls emerged regarding the thickness of preocular tear film, corneal epithelium, Bowman layer, corneal stroma, and Descemet membrane-endothelium complex. The anterior scleral thickness values of 1, 3, and 5 mm from the limbus were similar in both patients with myopia and control participants (P > 0.05). There were no significant correlations between central cornea stromal thickness and anterior scleral thickness in myopic participants (P > 0.05). Conclusions: The thickness of anterior wall structures and preocular tear film of patients with moderate to high myopia are not statistically different compared with those of healthy controls. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Purpose: To determine the effect of peripapillary chorio­retinal atrophy in degenerative myopia on the retinal nerve fibre layer (RNFL) thickness measurements performed by scanning laser polarimetry. Methods: Polarimetric RNFL analysis was done in 41 degenerative myopic eyes of 25 patients with spherical refractive errors between −7.50 and −22.00 D (mean −12.50 D; SD 3.5). Analysis was also performed on 46 eyes of 24 age-matched healthy subjects with spherical refractive errors between −1.00 and +1.00 D (mean −0.25 D; SD 0.50) with GDx Nerve Fiber Analyzer (Version 1.0.12). All of the myopic patients had clinically evident peripapillary chorio­retinal atrophy in their fundus examination. Results: In myopic patients most of the GDx parameters were statistically different from the control group (P

Choroidal neovascularization (CNV) is one of the most important vision-threatening complications of degenerative myopia, occurring in up to 10% of highly myopic eyes. Optical coherence tomography (OCT

AIM: To investigate the correlation between degenerative myopia and diabetic retinopathy(DR). METHODS: Totally 106 cases with diabetes B were divided into the degenerative myopia group(48 cases)and the no degenerative myopia group(58 cases). Fundus examination and fluorescence fundus angiography(FFA)were performed on all cases. The occurrence and stage of DR were compared between the 2 groups. RESULTS: The occurrence of DR of the no degenerative myopia group(93.1%)was much higher than that of the degenerative myopia group(70.8%). Only retinopathy of stageⅠor Ⅱ was observed in the degenerative myopia group without lesion in proliferating phase, while retinopathy of stageⅠto Ⅴ could be found in the no degenerative myopia group.CONCLUSION: Degenerative myopia can prevent DR from occurrence and may be a protective factor for DR.

Degenerative myopia is a significant cause of vision loss; yet there is no accepted way of controlling its causative phenotype--progressive high axial myopia. Scleral reinforcement, introduced over 50 years ago, was discredited as a useful technique. This 5-year 'proof of concept' study examines buckling of the posterior pole for myopia control and follows the course of untreated fellow eyes.A total of 59 adult eyes, with myopic refractive corrections ranging from -9 to -22 D and axial lengths from 27.8 to 34.6 mm, were studied. A 1-cm-wide flexible buckle of donor sclera was positioned over the posterior pole and secured, under positive tension, to the anterior globe. The eyes were monitored for 5 years, as were unsupported fellow eyes. The axial lengths, visual acuities, and optical coherence tomography macular scans were collected and all complications were noted.Over 5 years, axial length control was achieved by scleral buckling, whereas axial extension progressed in the untreated group. No serious complication occurred and no eye lost visual acuity from the procedure. Temporary intra-ocular pressure elevation, small choroidal effusions, and variable periods of abduction limitation occurred after surgery. In one case of tractional myopic macular schisis, a full correction was achieved by buckling and visual acuity improved.

Purpose There is no accepted method for the control of progressive high axial myopia, the phenotype of Degenerative Myopia. Myopic Macular Degeneration was studied and classified by clinical presentation, structural features and responses to certain natural and therapeutic changes. Methods Two hundred eyes, with 9.0 D to 24.O D of axial myopia, were evaluated in terms of their clinical presentations, axial length and Optical Coherence Tomography images. The changes occurring with vitreous detachment, macular buckling, vitrectomy and the treatment of exudative complications were also evaluated. Results Vision loss progressed with the length of the eye, the shape of the posterior pole and the age of the patient. The macular degeneration was classifiable into: Atrophic, Exudative, Cicatricial and Neural-disruptive stages. Macular buckling stabilized axial length and corrected some features of macular traction. Vitrectomy and membrane peeling relieved other aspects of macular traction, but gave no restraint to axial myopia progression. Photo-dynamic-therapy and intra-vitreous anti-VEGF injections controlled exudative macular complications. Conclusion The stages of Myopic Macular Degeneration were: Atrophic, Exudative, Cicatricial and Neural-disruptive. Progression was related to time, axial length, posterior pole anatomy and vitreous detachment. Macular buckling limited axial myopia progress and modified schisis and other neural-disruptive features. It remains to be shown that such surgery can prevent myopic macular degeneration and preserve macular function. Additional vitreous surgery may be required for macular holes, detachments and pre-retinal fibrosis. Exudative changes were found to respond to treatments for the comparable stage of age-related macular degeneration.

The authors performed a prospective study of 36 eyes affected by pathologic myopia with macular subretinal neovascularization (SRNV) successfully treated with either argon green, dye orange (590 nm), or krypton red lasers. Re-treated eyes were excluded. Evolution of the laser scar was carefully monitored for 12 months. Scar expansion was noted in 35 cases (97%), without a significant loss of visual acuity during the first year after treatment. The scar enlarged more conspicuously during the first 3 months after photocoagulation, with a mean increase of 103% in the first year. Expansion was not related to laser wavelength, patient age, SRNV size, or degree of myopia. Scar enlargement was greatest in the same direction as that of maximal extension of the myopic peripapillary crescent; inspection of the morphologic configuration of the peripapillary crescent before laser treatment may be helpful in evaluating the potential risk of post-laser scar expansion toward the fovea. RETINA 10:239–243, 1990

Purpose To determine the influence of clinical features and Indocyanine green (ICG) angiographic features on the visual outcome of patients with myopic sub-foveal choroidal neovascularization (CNV) who received photodynamic therapy (PDT). Methods Thirty-six consecutive patients (39 eyes) with myopic CNV who were followed up for more than one year after PDT were enrolled in this study. Clinical features included age, gender, refractive error, great linear dimension, and subretinal hemorrhage. ICG features included the lesion size, lacquer cracks, hypofluorescence surrounding the CNV (dark rim), peripapillary atrophy size, and visible prominent choroidal veins under the macula. Linear regression analysis was performed using the change in visual acuity (ΔlogMAR) as the dependent variable and the above factors as independent variables. Results At one-year follow-up after PDT, a younger age (p=0.002) and the presence of a dark rim (p=0.002) were significantly correlated with an improvement of visual acuity (decrement in logMAR) after PDT. Other factors had no significant influence on changes in visual acuity. Conclusions Younger patients and patients with a dark rim on ICG angiography had a higher chance of visual improvement after PDT in myopic CNV.

Purpose: The purpose of this study was to evaluate disease severity in a population of keratoconic patients utilising corneal gas permeable lenses within the Illinois Institute. Method:With the approval of the internal reviewboard, a query of our contact lens ordering systemwas performed searching for all patients for whom any keratoconic lens design had been ordered within the last ten years. All large diameter, scleral, and piggybackwearerswere excluded. Patientswere further excluded if they suffered from other significant ocular disease including glaucoma, corneal transplant, amblyopia and degenerative myopia. Finally, the charts of 331 patients were reviewed for data related to their keratoconus. Results: The average of the mean K readings was 51.84D+6.60. The flat K readings ranged from 33.50D to 85.75D with an average of 49.19D+6.19. In our population the average steep K was 54.49D+7.64 and ranged from 40.38 to 93.14 diopters. Utilising CLEK criteria of 45 diopters for mild keratoconus, only 11.8% of our patients fell into the mild category. Additionally, 39.0% of our patientswere categorised as severewith averageK readings greater than 52 diopters. 11.5% of our keratoconus patients exceeded an average K reading of 60 diopters. Seventeen percent had corneal scarring. Conclusions: With its over 1500 patients and greater than 30 publications The Collaborative Longitudinal Evaluation of Keratoconus (CLEK) has become the standard by which we evaluate keratoconus. The utilization of CLEK criteria seems to indicate that our patients frequently experience severe disease, 39% of the time.

Purpose: To investigate the short-term effect of intravitreal bevacizumab injection for choroidal neovascularization associated with degenerative myopia. Methods: In 15 eyes of 15 patients, one or two consecutive intravitreal bevacizumab injections were given. The best-corrected visual acuity (BCVA) and fundus examination were evaluated at baseline and monthly thereafter. Fluorescence angiography (FA) was performed at baseline, 1 month and 3 months after treatment. When the angiographic leakage persisted 1 month after the first injection, a second injection was administered. Results: The mean follow-up period was 9.7 months. The mean logarithm of the minimum angle of resolution (LogMAR) BCVA was 0.810.44 at baseline, 0.640.41 at 3 months (p=0.005), and 0.600.41 (p=0.001) at the final examination. Five eyes received a single injection, while the other ten eyes had two consecutive injections. Three months after the first injection, 14 eyes (93.3%) had no angiographic leakage, and 1 eye (6.7%) showed a decrease in leakage. The mean lines of visual improvement at 3 months and at the final examination were 1.7 and 2.1 lines, respectively. No case of vision loss was observed throughout the follow-up period. Conclusions: One or two consecutive intravitreal bevacizumab injections had favorable short-term effects on visual acuity stabilization and the regression of choroidal neovascularization associated with neovascular degenerative myopia.

In 153 eyes with idiopathic posterior subretinal neovascularization (IPSN) and myopia of no greater than −6 dpt, the relative risk of this disorder was determined with regard to refraction. It was shown that the probability of developing this condition is directly proportional to the degree of myopia. By using data obtained from the literature for calculating the relative risk regarding refraction, it was demonstrated that the same is true for subretinal neovascularization in degenerative myopia greater than −7.5 dpt (Fuchs' spot). The relative risk for developing one of both disorders increases exponentially with increasing myopia.

Laser photocoagulation of extrafoveal choroidal new vessels was performed in 19 eyes with degenerative myopia. Sixteen eyes required only one treatment. Three eyes required more than one because of incomplete closure of the new vessels after the first treatment. Choroidal new vessel formation did not recur during the post-treatment follow-up period (average 29.2 months), and a dry, atrophic photocoagulation scar was achieved in all eyes. Visual acuity improved in only two eyes (11%), stabilized in four eyes (21%), and deteriorated in 13 eyes (68%). All except two eyes showed spontaneous progressive enlargement of the atrophic photocoagulation scar, which worsened visual acuity in 13 eyes (68%).

To see whether or not reduced light input in children with congenital cataract produces degenerative myopia and whether it is associated with an impairment of the hypophyseal-adrenal cortical axis, the authors studied biometric values and circadian rhythm and cortisol reserve in nine children with monolateral and ten children with bilateral cataract. 38.75% of patients had: refractions less than 10D, increased antero-posterior diameter of the eyeball, varying degrees of myopic chorioretinitis, showing that the lack of light input induces degenerative myopia only in a group of patients who are probably genetically predisposed. The negative correlation between cortisol reserve and ocular lesions seems to reveal a precocious negative effect of the lack of light input on the development of the hypothalamic-hypophyseal-adrenal cortical axis. The alteration of the circadian cortisol rhythm and the reduction of the cortisol reserve found exclusively in children with monolateral cataract must be studied further to be explained. The slight increase in plasma cortisol levels earlier described in adults with acquired degenerative myopia was not found in children with congenital cataract. This difference could be due to: special endocrine characteristics in children with congenital cataract, endocrine differences between childhood and adulthood, differing influences of hormonal factors on myopia, or vice versa, in childhood and adulthood.

Continuing their study of the ethiopathogenesis of high myopia, the authors have determined serum Cortisol, testosterone, 17 β-estradiol, progesterone and urinary 17-KS and 17-OHCS, in a group of 55 males and 32 fecund females with high myopia (above — 10 D); the patients were strictly selected, excluding from the study all cases with signs of systemic disease.

To the Editor.— Regarding Dr Curtin's answer to Dr Pika's 1 question about bilateral high myopia, I respect Dr Curtin's great contributions to our knowledge concerning high myopia and degenerative myopia. However, he missed answering the following points. The first concerns the management of the 3 1/2-year-old male with severe myopia. This condition, when congenital, is not apt to progress. Therefore, it could not be considered degenerative at this point and surgery is definitely not indicated. I advise fitting contact lenses as soon as cooperation with the youngster can be obtained. This will provide the greatest visual rehabilitation and visual development. Second, Dr Curtin indicates that scleral reinforcement surgery is not useful. I wish to refute this and refer the readers to my article concerning scleral reinforcement surgery published in the Transactions of the American Academy of Ophthalmology (November-December 1974). In addition, I presented an exhibit at the