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Diagnosis Myopic Neovascularization.pptx

  1. Diagnosis Myopic Neovascularization
  2. Clinical Characteristics Visual Loss Scotomata Distortion of Vision Spaide, R.F., Ohno-Matsui, K. and Yannuzzi, L.A. (2021) Pathologic myopia. Cham, Switzerland: Springer.
  3. Advanced Myopic Degeneration Prior impairments vision from : • Lacquer cracks : Mechanical dehiscence of Bruch’s membrane occurs, produce thin branching lines in the posterior pole • Atrophy : translucent defects with clearly discernible underlying choroidal vessels • Staphyloma Spaide, R.F., Ohno-Matsui, K. and Yannuzzi, L.A. (2021) Pathologic myopia. Cham, Switzerland: Springer.
  4. Clinical Finding Sub or Intraretinal Fluid Subretinal Hemorrhage Elevation and Infiltration of the outer retina Localized area of Pigmentary Change 2022-2023 BCSC: Basic and clinical science course 12 Retina and Vitreous (2022). San Francisco: American Academy of Ophthalmology.
  5. Progression of Myopic CNV INITIALDirect Damage to Photoreceptors Vision Loss THEN CNV regresses, a Fibrous Pigmented Scar is formed. END Chorioretinal atrophy develops around the regressed CNV, Results Poor Long Term Visual Outcome. Myopic CNVM (2022) EyeWiki. Available at: https://eyewiki.aao.org/Myopic_CNVM (Accessed: February 15, 2023).
  6. Diagnostic
  7. Fluorescein Angiography
  8. Fluorescein Angiography Demonstrates the Vascular Ingrowth  Early Hyperfuorescence with variable amounts of leakage later in the angiographic sequence Fluorescein angiography showed a hyperfuorescent lesion consistent with choroidal neovascularization Spaide, R.F., Ohno-Matsui, K. and Yannuzzi, L.A. (2021) Pathologic myopia. Cham, Switzerland: Springer.
  9. The fuorescein angiogram shows a hyperfuorescent lesion seen early with pronounced leakage consistent with type 2 neovascularization In the choroidal phase, more details of vessels are visible due to thinning of overlying RPE  Well-defined hyperfluorescence often with a hypofluorescent rim of pigmentation in the early phase with progressive leakage of dye in the late phase of the angiogram. A rim of subretinal hemorrhage is seen along the area of CNVM which causes blocked fluorescence. Spaide, R.F., Ohno-Matsui, K. and Yannuzzi, L.A. (2021) Pathologic myopia. Cham, Switzerland: Springer.
  10. Early phase  Early visualization of the vascular network. Note the separation between the vessels and the hypopigmented area Later phase  Leakage from the vessels, which is another angiographic characteristic required to make the diagnosis of classic choroidal neovascularization. Spaide, R.F., Ohno-Matsui, K. and Yannuzzi, L.A. (2021) Pathologic myopia. Cham, Switzerland: Springer.
  11. Optical Coherence Tomography (OCT)
  12. Optical Coherence Tomography (OCT) Signs Exudation  Intra-or Subretinal fluid and hyperrefective subretinal material in eyes with myopic CNV. OCT angiography  show the neovascularization in both the B-scan with fow overlay and the en face sections The infltration causes a low, fat alteration in the contour of the RPE monolayer. The exudation and infltration cause boundary between the lesion and outer retina to become less well-defned or “fuzzy.” Loss of exudative manifestations, associated with the boundary becoming more welldefned Spaide, R.F., Ohno-Matsui, K. and Yannuzzi, L.A. (2021) Pathologic myopia. Cham, Switzerland: Springer.
  13. Myopic CNVM (2022) EyeWiki. Available at: https://eyewiki.aao.org/Myopic_CNVM (Accessed: February 15, 2023). Spectral Domain- OCT (SD-OCT) Hyper-reflective lesions with fuzzy borders at the RPE, central ellipsoid, and external limiting membrane. Subretinal hemorrhage, intraretinal fluid , subretinal fluid or RPE detachment may also be seen. Enhanced depth imaging (EDI) enables visualization of choroid layers as well which typically demonstrates atrophy in myopic eyes without CNVM and fibrosis or thickening in myopic eyes with CNVM present
  14. Swept Source - OCT • For diagnosis and follow-up of myopic CNVM. • Chorioretinal thinning along with subretinal membrane may be seen • Better delineation of choroid layers is also possible with SS-OCT. Myopic CNVM (2022) EyeWiki. Available at: https://eyewiki.aao.org/Myopic_CNVM (Accessed: February 15, 2023).
  15. OCT-A • Helps in differentiation of the subretinal hemorrhage caused by both CNVM and new lacquer crack formation. • Active CNV  lacy wheel pattern, numerous tiny capillaries, a widely anastomosed network, and a perilesional hypointense halo while quiescent CNV are characterized by long filamentous linear large mature looking vessels, rare anastomosis and a "dead tree" appearance • OCT-A successfully detecting up to 94.1% of myopic CNVs. Myopic CNVM (2022) EyeWiki. Available at: https://eyewiki.aao.org/Myopic_CNVM (Accessed: February 15, 2023).
  16. Myopic CNVM (2022) EyeWiki. Available at: https://eyewiki.aao.org/Myopic_CNVM (Accessed: February 15, 2023).

Notes de l'éditeur

  1. Spaide, R.F., Ohno-Matsui, K. and Yannuzzi, L.A. (2021) Pathologic myopia. Cham, Switzerland: Springer.
  2. AAO, Myopic book, https://openi.nlm.nih.gov/detailedresult?img=PMC3380683_jovr-5-2-194-688-2-pbf29&req=4 (subret fluid)
  3. Buku miop
  4. Buku miop, eyewiki
  5. Buku miop
  6. eeyewiki
  7. eyewiki
  8. eyewiki
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