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Objective To observe the effect of oral glucocorticoid combined with ocular hypotensive drugs on the development of myopia in patients with pathologic myopia (PM) complicated with multifocal choroiditis (MFC). Methods A total of 56 PM patients (76 eyes) with MFC were collected, and they were treated with moderate-dose glucocorticoid (prednisone acetate) orally, with an average course of 13.5 weeks. At the same time, they were combined with brinzolamide eye drops for 24 months. Axial length (AL), spherical equivalent (SE), intraocular pressure, best corrected visual acuity (BCVA) and mean sensitivity of visual field ( mean sensitivity, MS) were followed-up and recorded at 3 months, 6 months, 12 months, 18 months and 24 months. Results After treatment, the color image of the fundus showed that the lesion area was slightly smaller than that before treatment, and the leakage of FFA fluorescein was improved compared with that before treatment. Compared with before treatment, there were no significant differences in AL, SE and intraocular pressure only at 3 months after treatment, and there were no significant differences in AL and SE at 24 months after treatment. Compared with before treatment and 3 months after treatment, there were significant differences in each index at 6, 12 and 18 months after treatment (P＜0.05). There were significant differences in BCVA and visual field MS at different time points between 3, 6 and 24 months after treatment (P＜0.05). At 3 and 24 months after treatment, there was no correlation between AL and intraocular pressure and SE. At 6, 12 and 18 months after treatment, AL was positively correlated with intraocular pressure and negatively correlated with SE (P＜0.01). Conclusion Oral glucocorticoid combined with ocular hypotensive drugs to treat PM with MFC can control the growth of PM AL and myopia diopter, and effectively improve visual function. [ABSTRACT FROM AUTHOR]

Pathological myopia (PM) is the leading ocular disease for impaired vision worldwide. Clinically, the characteristics of pathology distribution in PM are global-local on the fundus image, which plays a significant role in assisting clinicians in diagnosing PM. However, most existing deep neural networks focused on designing complex architectures but rarely explored the pathology distribution prior of PM. To tackle this issue, we propose an efficient pyramid channel attention (EPCA) module, which fully leverages the potential of the clinical pathology prior of PM with pyramid pooling and multi-scale context fusion. Then, we construct EPCA-Net for automatic PM recognition based on fundus images by stacking a sequence of EPCA modules. Moreover, motivated by the recent pretraining-and-finetuning paradigm, we attempt to adapt pre-trained natural image models for PM recognition by freezing them and treating the EPCA and other attention modules as adapters. In addition, we construct a PM recognition benchmark termed PM-fundus by collecting fundus images of PM from publicly available datasets. The comprehensive experiments demonstrate the superiority of EPCA-Net over state-of-the-art methods in the PM recognition task. For example, EPCA-Net achieves 97.56% accuracy and outperforms ViT by 2.85% accuracy on the PM-fundus dataset. The results also show that our method based on the pretraining-and-finetuning paradigm achieves competitive performance through comparisons to part of previous methods based on traditional fine-tuning paradigm with fewer tunable parameters, which has the potential to leverage more natural image foundation models to address the PM recognition task in limited medical data regime., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)