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Professor Song Zongming talks about the grading and treatment of myopic macular degeneration

Posting time:2022-12-03 10:11:23

Professor Song Zongming talks about the grading and treatment of myopic macular degeneration

Editor's note: As we all know, the macula is the part of the retina that can have a serious impact on vision, and is mainly related to visual functions such as fine vision and color vision. Myopia (especially high myopia) is often associated with macular degeneration, which may have a greater impact on the visual quality of patients, so myopic macular degeneration must be properly treated. However, there are many types of myopic macular degeneration, and the treatment cannot be generalized. In order to improve the ability of ophthalmologists in the differential diagnosis and treatment of various types of myopic macular degeneration, "International Ophthalmology News" specially invited Professor Song Zongming from Henan Provincial Eye Hospital to share his clinical experience in this regard. Professor Song not only introduced the myopic macular degeneration The grading of lesions also gives specific treatment suggestions, pointing out the direction for solving practical clinical problems. An overview of myopic macular degenerationAs people age, myopic patients tend to experience progressive axial lengthening, which in turn leads to the appearance of peripheral retinal lesions, including lattice degeneration, snail trail degeneration, pigment block degeneration, chorioretinal degeneration, pavement Stone degeneration, cracks, whitening (no pressure whitening, pressure whitening) and vitreous changes (traction, adhesion, sticking), etc. (Figure 1). Figure 1. Myopic peripheral retinal changes. Myopic patients may also have a variety of lesions in the macula, such as degenerative atrophy (scleral pit or staphyloma, retinal degeneration, choroidal atrophy), proliferation (choroidal neovascularization, Fuchs spots), Myopic traction macular degeneration (macular schizophrenia, epimacular membrane, macular hole, macular hole retinal detachment), etc., these diseases can seriously affect the vision of patients. In order to properly treat myopic macular degeneration patients, the following definitions and key points must first be clarified: Myopic traction maculopathy: pathological myopia, with preretinal traction in the macula; macular schizophrenia (MS): macular retinal Internal fluid, cysts, and delamination, which can develop into holes; epimacular membrane: preretinal proliferative tissue; macular hole (MH): divided into lamellar holes and full-thickness holes, which can be developed from splitting or can initially manifest It is a hole; MS, MH and epiretinal membrane can be concurrent or transformed; macular hole retinal detachment: MH is accompanied by retinal detachment, the range is greater than 1 DD. Myopic macular degeneration is common in highly myopic eyes. Due to the posterior expansion of the posterior pole, the tension of the retina and choroid in the macular area increases. After vitreous liquefaction and splitting, macular holes are prone to occur, followed by retinal retinal break away. In addition, highly myopic eyes have features such as lacquer cracks, foveal hemorrhage, or choroidal neovascularization, and patients often seek medical attention with sudden and significant reduction in visual acuity, visual distortion, or fixed central scotoma (Figures 2 and 3). Figure 2. Development process of myopic traction maculopathyFigure 3. Grading of macular degeneration in high myopia After understanding the development process of myopic macular degeneration, it can be graded (Figure 4): Figure 4. Grading of myopic macular degeneration Recommendations for the treatment of myopic macular degeneration 1. If a patient with myopic macular degeneration has only symptoms of macular hemorrhage, it can be observed first without special treatment. The bleeding of some patients can be absorbed within a few weeks or months. 2. Patients with myopic macular degeneration with neovascularization can be treated with anti-vascular endothelial growth factor. 3. Pathological myopic macular holes require vitreous surgery, removal of the vitreous or further stripping of the inner limiting membrane to facilitate the closure of the hole. 4. Surgery is the only effective treatment for macular holes that have already led to retinal detachment. Most patients with full-thickness macular holes can be treated well with modern minimally invasive vitrectomy, but for some huge macular holes, conventional surgery is difficult to achieve an ideal prognosis. In order to make patients with giant macular hole get better treatment effect, Professor Song Zongming has innovatively used viscoelastic agent-assisted internal limiting membrane inversion covering technology to treat such patients since 2014, and has achieved very good results. The patient's visual acuity was significantly improved (Figure 5, 6). Figure 5. Overview of patients with giant macular hole before surgeryFigure 6. Overview of patients with giant macular hole after viscoelastic-assisted internal limiting membrane inversion covering Classification of holes and reference to surgical treatment (Figure 8), and a summary of the management of myopic macular degeneration requiring surgical treatment: macular schizophrenia/traction maculopathy: PPV+PV-P+/-gas filling, PPV+ PV-P + fovea-preserving ILM peel +/- gas filling; detachment split: posterior scleral cuff; macular hole retinal detachment: PPV + PV-P + ILM-P + intraocular filling (small hole, small RD extent ), PPV+PV-P+ILM inversion packing+autologous blood+intraocular filling; retinal detachment at the posterior pole, paravascular hole: PPV+PV-P+laser+intraocular filling. Figure 7. Suggestions for the treatment of myopic macular degeneration Figure 8. Reference summary of macular hole classification and surgical treatment Professor Song finally concluded that the incidence of myopic fundus lesions is high, the lesions are diverse and progressive, involve many disciplines, and compare clinical treatments tricky. Myopic fundus lesions have certain regularity and have been graded, but the grading is not scientific enough, and there is still room for improvement. Currently treatable myopic fundus diseases include choroidal neovascularization, retinal detachment, macular schisis and hole, and atrophy and degeneration are currently untreatable. Expert profile Professor Song Zongming is the executive vice president of Henan Provincial Eye Hospital, the executive deputy director of the research institute, and the director of the Department of Ophthalmology of the Provincial People's Hospital. Expert member of Chinese Medical Association, member of ophthalmology branch, member of fundus disease group; member of standing committee of ophthalmology branch of Chinese Medical Doctor Association; chairman of ophthalmology branch of provincial medical association, chairman of provincial preventive medicine association public health ophthalmology branch, and president-elect of ophthalmology branch of provincial medical association Committee; Deputy Editor-in-Chief of "Chinese Journal of Experimental Ophthalmology", editorial board member of several core journals. He is good at diagnosis and treatment of complex retinal detachment, complex ocular trauma, high myopia fundus disease, diabetic fundus disease and macular disease. Invented intraocular colored perfusate, minimally invasive cannula to remove 5000mps high-viscosity silicone oil, improved ILM rollover cover, and ILM tamponade to treat refractory macular holes, etc. He has published more than 100 papers, presided over and participated in the compilation of many monographs, teaching materials and diagnosis and treatment specifications, and obtained 5 national patents.

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