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. 2003 May;87(5):570-3.
doi: 10.1136/bjo.87.5.570.

Patchy atrophy and lacquer cracks predispose to the development of choroidal neovascularisation in pathological myopia

K Ohno-Matsui  1 , T Yoshida, S Futagami, K Yasuzumi, N Shimada, A Kojima, T Tokoro, M Mochizuki
Affiliations

Patchy atrophy and lacquer cracks predispose to the development of choroidal neovascularisation in pathological myopia

K Ohno-Matsui et al. Br J Ophthalmol. 2003 May.

Abstract

Aims: To determine the incidence and predisposing findings for choroidal neovascularisation (CNV) in a large series of highly myopic patients.

Methods: The medical records of 218 consecutive patients (325 eyes) with myopic fundus changes in the macula were reviewed. The incidence of CNV during a follow up of at least 3 years of highly myopic patients and identification of predisposing findings for the development of myopic CNV were examined.

Results: Among 325 highly myopic eyes examined, 33 eyes (10.2%) developed myopic CNV. The incidence was higher (34.8%) among the fellow eyes of patients with pre-existing CNV than among eyes of patients without pre-existing CNV (6.1%). CNV developed in 3.7% with diffuse chorioretinal atrophy, in 20.0% with patchy atrophy, and in 29.4% with lacquer cracks.

Conclusion: Approximately one in 10 highly myopic eyes developed myopic CNV in average 130.2 months. Patchy atrophy and lacquer cracks were shown to be important predisposing findings for CNV development.

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Figures

Figure 1
Figure 1
Representative photographs of myopic fundus changes. (A) Diffuse chorioretinal atrophy. A yellowish-white spotty lesion is observed in the macular area. (B) Lacquer cracks. A yellowish linear lesion is observed in the macula (arrow). (C) Patchy atrophy. A greyish-white, well defined lesion of 2 disc diameters is observed in the inferotemporal part of the fovea centralis.
Figure 2
Figure 2
Development of myopic CNV at the edge of the area of patchy atrophy. Patient 1. A 47 year old woman. (A) Left fundus at the initial examination (January 1991) showed an area of patchy atrophy below the macula (arrows). (B) Two years later (August 1993), the area of patchy atrophy enlarged and coalesced (arrows). (C) One year later (June 1994), CNV developed at the macular edge of the area of patchy atrophy (arrows). Subretinal bleeding was observed around the CNV (arrowheads). (D) Fluorescein angiogram at the onset of CNV. At 2 minutes after dye injection, there was intense hyperfluorescence corresponding to the site of the CNV (white arrow). The patient’s visual acuity dropped from 20/25 to 20/70.
Figure 3
Figure 3
Development of myopic CNV from lacquer cracks. Patient 3. A 28 year old woman. (A) Left fundus at the initial examination (November 1993) revealed two lacquer cracks above the macula (arrows). (B) Fluorescein angiogram at the initial examination showed linear hyperfluorescence corresponding to the lacquer cracks (arrows). (C) Three years later (December 1996), CNV developed at corresponding site of previous lacquer crack (arrow). (D) Fluorescein angiogram at the onset of CNV. At 1 minute after dye injection, there was intense hyperfluorescence corresponding to the site of the CNV (arrow). The patient’s visual acuity dropped from 20/20 to 20/200.
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