A small fraction of myopic people has pathologic myopia, in which the tissues of the eyes are stretched and damaged to various degrees. Lacquer cracks were observed bilaterally in 14 patients and unilaterally in the other 19 patients. It is believed that lacquer cracks as well as other macular degenerative changes in pathologic myopia are caused by mechanical stretching of the retina and. Lacquer cracks in pathologic myopia retina image bank. Lacquer cracks have only been observed in the posterior pole of highly myopic eyes. Browning md, phd myopia, or nearsightedness, is common, occurring in approximately one third of all adults. A possible causal relationship article in american journal of ophthalmology 1604. It is now recognized that myopic cnv can occur in patients with any degree of myopia, even in the absence of characteristic degenerative retinal changes. Patchy atrophy and lacquer cracks were shown to be important predisposing findings for cnv development. Peripheral lacquer cracks as an early finding in pathological myopia arch ophthalmol. Lacquer cracks, which are a hallmark of pathologic myopia, typically appears as yellowish linear lesions in the posterior pole of the eye and are widely considered to be mechanical breaks in the rpebmcc complex secondary to excessive axial elongation. The exact pathogenesis and pathophysiology of angioid streaks is not known.
A crosssectional evaluation including bestcorrected visual acuity bcva, axial length, refractive error, color fundus photography, and spectral domain optical coherence tomography sdoct was. Progression patterns of lacquer cracks include an increased number, elongation, and progression to patchy atrophy 8, 26. To clarify the pathophysiology of linear hypofluorescent lesions observed by fluorescein angiography fa in the posterior fundus of eyes with pathologic myopia and to compare the features of these lesions with those of lacquer cracks. Choroidal neovascularisation in pathological myopia. We considered lacquer cracks fig 1b 1b as a separate category in the present study because a previous report described an important relation between myopic cnv and lacquer cracks. The lrp2 knockout mice, retinopathy globe enlarged rge chicks, and normal lidsutured chicks exhibit features typical for myopic maculopathy in patients and could serve to.
Longterm natural outcomes of simple hemorrhage associated. Myopic choroidal neovascularization american academy of. Myopic cnv develops in 10% of highly myopic patients,15 and 30% of the patients who have cnv in one eye eventually develop cnv in the. The background maculopathy level was c1 tessellated fundus in nine eyes 19. Lacquer cracks are considered to be healed mechanical fissures in the retinal. A crosssectional evaluation including bestcorrected visual acuity bcva, axial length, refractive error, color fundus photography, and spectral domain optical coherence tomography sdoct. Lacquer cracks are uncommon findings in the posterior pole of highly myopic eyes with a prevalence ranging from 4. They are broader at the point of origin at the optic nerve and taper to a point as they branch out from the disk margin. Diagnosis and treatment of cnv in myopic macular degeneration.
We report a case with lacquer cracks observed in the peripheral fundus. Lacquer cracks can be detected by noninvasive fundus autofluorescence and optical coherence tomography. In the present study, diffuse atrophy was defined as yellowish fundus without lacquer cracks. Lacquer cracks predispose patients with high myopia to have sudden visual loss as macular cnv may develop in close proximity to the lacquer cracks. Lacquer cracks observed in peripheral fundus of eyes with high myopia mitsuki suga, kosei shinohara, kyoko ohnomatsui department of ophthalmology and visual science, tokyo medical and dental university, tokyo, japan abstract. New york, new york pathologic myopia is a major cause of blindness, the incapacitating visual effects of which occur commonly during the pro ductive years of young adulthood. In other words, degenerative changes are not susceptible to therapy.
Clinical sciences peripapillary detachment in pathologic. If you start to develop new blood vessels at the macula, this can be treated with antivascular endothelial growth factor antivegf treatment. D lacquer cracks are observed as yellowish, linear lesions arrows. Lacquer cracks following laser treatment of choroidal. Angioid streaks appear as bilateral, narrow, jagged lines, deep to the retina. Oct imaging and novel therapies have improved outcomes in eyes with myopic cnv and myopic macular retinoschisis. Oct 01, 2018 breaks in bruchs membrane are the main drivers for progression to the more severe grades of mmd. Medical records of 47 highly myopic eyes with lcs were examined. Nov 01, 2019 roughly 5% to 11% of patients with pathologic myopia will develop myopic cnv, and 35% of those with myopic cnv will develop bilateral involvement. Methodsthe authors studied 66 eyes 53 patients with lacquer cracks, using general ocular examinations and fluorescein angiography once every 3 to 12 months. To investigate the relationship between simple hemorrhage sh associated with lacquer crack lc and myopic choroidal neovascularization cnv in high myopia. This was a retrospective and consecutive case series study of lacquer cracks in eyes with pathologic myopia. Lacquer cracks detected in rge chicks subsequently progressed to patchy chorioretinal atrophy, which is also commonly seen in patients with pathologic myopia.
The progression of lacquer cracks in pathologic myopia. The optic disc displays tilting and temporal flattening, there is a posterior staphyloma, and macular hemorrhage thin white arrow is present near the lacquer cracks. Intravitreal bevacizumab for choroidal neovascularization attributable to pathologic myopia. The detection rate of lcs was 98% in fundus photographs and 85% by fundus autofluorescence and optical coherence tomography. Diagnosis and treatment of myopic maculopathy retina today. Patchy atrophy and lacquer cracks predispose to the development of. Lacquer cracks are breaks in the retinal pigment epithelialbruchs membranechoriocapillaris complex and are manifestations of pathologic. What you should know about pathologic myopia by david j.
From the files of two retinal referral practices, five patients were located in whom lacquer cracks developed or expanded after laser photocoagulation for macular cnv in pathologic myopia. In particular, lacquer cracks, myopic schisis, or choroidal neovascularization in the macula area and holes or tears in the periphery of the retina. Considering that bruch membrane defects were also observed in myopic cnvrelated foveal atrophy, macular bruch membrane defect might be a common finding in fundus lesions related to pathologic myopia. The clinical significance of subretinal bleeding without choroidal neovascularization in pathologic myopia is unclear. These breaks can arise from lacquer cracks or myopic cnv.
The vitreoretinal manifestations in pathological myopia are associated with varying degrees of visual loss and they include posterior staphyloma, diffuse or patchy chorioretinal atrophy, retinal pigment epithelial atrophy, lacquer cracks, spontaneous subretinal haemorrhages, and macular choroidal neovascularisation cnv. The analysis of lacquer crack in the assessment of myopic choroidal. Curtin and karlin 12 reported that lacquer cracks were found in 4. Look for lacquer cracks in high myopes for early warning of.
The eyes of men have a 2fold incidence of lacquer cracks as compared with those of women. Different dosing of intravitreal bevacizumab for cnc because of pathologic myopia retina. A small fraction of myopic people has pathologic myopia, in which the tissues of the eyes. Pathological myopia is the leading cause of severe visual loss in many countries. The loss of bcva is caused by the development of myopic macula patchy, myopic traction macula patchy, and myopic optic neuropathy or glaucoma. Complicated retinal pigment epithelium humps in high myopia. Retinal physician easily misdiagnosed retinal entities. The diagnosis of degenerative myopia is accompanied by characteristic chorioretinal degenerations. The beginning stages of posterior staphylomas are very difficult to discern on physical exam for runofthemill retinal specialists or general ophthalmologists. Lacquer cracks generally occur in the posterior pole of the fundus, and to date, there has been only one case report on lacquer cracks that appeared in the peripheral fundus. Patchy atrophy and lacquer cracks predispose to the. Lacquer cracks axial ruptures inbruchsmembrane which small haemorrhages may occur. Thus, new classification is expected to include only the lesions specific to pm thus, c2, c3, c4, lacquer cracks, myopic cnv and it is better to call pm maculopathy.
Lacquer cracks are found in the posterior fundus of 4. Myopia and pathologic myopia pm are among the leading causes of visual impairment in the world. Resultsthe lacquer cracks progressed in 37 eyes 56. However, treatment options are available for several additional complications. Macular bruch membrane holes in highly myopic patchy. Ophthalmology grand rounds suny downstate medical center. Appear as a yellowwhite line in eyes with pathological myopia. Another type of thinning retina characteristic of myopic degeneration occurs at one of the deep layers called bruchs membrane. We report a patient with high myopia with lacquer cracks observed in the peripheral fundus.
However, lacquer cracks are a classical symptom of myopic degeneration and while your condition may remain stable for many years, the odds are more in favor of problems as you age. Lacquer cracks conditionkeywords pathologic myopia, lacquer cracks imaging device fundus camera description color fundus photograph of a 48yearold woman with lacquer cracks in the setting of pathologic myopia. Apr 19, 20 lacquer cracks conditionkeywords pathologic myopia, lacquer cracks imaging device fundus camera description red free fundus photograph of a 48yearold woman with lacquer cracks in the setting of pathologic myopia. Retinal physician diagnosis and management of pathologic myopia. This set of images is from a 55yearold asian woman with pathologic myopia. Only two reports in the ophthalmic literature have demonstrated the clinical course of subretinal bleeding and have indicated that it might be a precursor of lacquer cracks. Assessment of visual fields and amsler grid testing may be beneficial.
There are several proposed mechanisms for the development. They are typically less than 1 disc diameter in size and are located between the neurosensory retina and the rpe. In the present case, they were present in the midperiphery of the eye, a. Based on topographic correspondence visible only with octa, he speculates that perforating vessels may be consequential for choroidal neovascularization. Myopia and pathological myopia rnib see differently. Francesco bandello, md, demonstrates how octa depicts unique pathologic features of lacquer cracks secondary to pathologic myopia. The membrane forms in response to elevated vegf and occurs primarily in the presence of lacquer cracks also associated with high myopia. Lacquer cracks are fine, irregular, yellow lines, often branching and crisscrossing, seen in the posterior fundus of highly myopic eyes figure 1. Lacquer cracks observed in peripheral fundus of eyes with high. The diagnosis is usually made or suspected by clinical examination alone and can by confirmed with fluorescein angiography, which is important to rule out associated choroidal neovascularization.
Lacquer cracks and perforating scleral vessels in pathologic. Lacquer cracks are typical clinical findings in a highly myopic fundus and should alert the clinician to the possibility of retinal hemorrhage with or without cnvm. Retina today diagnosis and treatment of myopic maculopathy. Roughly 5% to 11% of patients with pathologic myopia will develop myopic cnv, and 35% of those with myopic cnv will develop bilateral involvement. Look for lacquer cracks in high myopes for early warning. Lacquer cracks lacquer cracks are formed by spontaneous ruptures in the bruchs membrane and small haemorrhages may develop within the lacquer cracks. Unfortunately, not all the changes that happen in pathological myopia, such as retinal atrophy and lacquer cracks, can be treated. Lacquer cracks were detected more frequently in the temporal 44. A thorough macular examination and peripheral depressed examination are key to detecting complications related to pathologic myopia.
In the metapm meta analyses of pathologic myopia study classification, pathologic myopia has been defined by the presence of myopic chorioretinal atrophy equal to or more serious than diffuse. Cnv is related to myopia itself and its incidence varies from 4 to 11 percent in patients with high myopia. Aug 01, 2019 the presence of linear hyperfluorescence on the fundus fluorescein angiography ffa was used as the standard for diagnosing the presence of lcs. Lacquer cracks are considered to represent mechanical fissures in the retinal pigment epitheliumbruch s membranechoriocapillaris complex secondary to eyeball elongation in highly myopic eyes. Pathologic myopia is the major cause of the loss of the bestcorrected visual acuity bcva worldwide, especially in east asian countries. They typically are configured as irregular radiations from a ringlike area of peripapillary pigment mottling. Full text lacquer cracks observed in peripheral fundus of. Jul 22, 2009 cnv is related to myopia itself and its incidence varies from 4 to 11 percent in patients with high myopia. What you should know about pathologic myopia retina reference.
Patchy atrophy and lacquer cracks predispose to the development of choroidal neovascularization in pathologic myopia. Fluorescein leakage within recent subretinal hemorrhage in. For educational purposes, in this chapter, complications of pathologic myopia will be divided into anterior when structures external to the globe or anterior to the ora serrata are involved, such as motility disturbances and cataract and posterior when structures posterior to the ora serrata are involved, such as lacquer cracks. It progresses rapidly, and visual outcome depends largely on the extent of fundus and lenticular changes. Peripheral lacquer cracks as an early finding in pathological. In addition, lacquer cracks have been found to be associated with cnv in up to 82 percent of cases with myopia. Pathologic myopia is the most common cause of macular cnv in patients younger than 50 years. This study examined lacquer cracks as a possible consequence of laser photocoagulation of cnv.
Three additional features were added to these categories and were included as plus signs. Lacquer cracks usually present as window defect on fa. Full text lacquer cracks observed in peripheral fundus. Lacquer cracks and perforating scleral vessels in pathologic myopia. Pathologic myopia is a major cause of irreversible vision loss and blindness worldwide, and in particular in east asia. Patchy atrophy category 3 develops around lacquer cracks and may expand to involve the fovea patchy related macular atrophy, category 4. They represent healed and mechanical breaks of the retinal pigment epithelium, bruchs membrane, and choriocapillaris complex. Lacquer cracks consist of ruptures in the retinal pigment epithelium rpebruchs membranechoriocapillaris complex. The authors felt that patients with high myopia really rely on their optometrist at yearly eye exams and these patients want to feel confident in their od. Myopic macular degeneration mmd has emerged as one of the leading causes of blindness or low vision in developed nations, particularly in east asia, where the prevalence of myopia is high. Lacquer cracks have been considered to represent breaks in bm 9, 23, 24, 25. Longterm visual outcome of choroidal neovascularization in pathologic myopia. In japan, pathological or high myopia reportedly affects 6% to 18% of the myopic.
Clinical photograph and optical coherence tomographic oct scan of a 48yearold man showing peripapillary detachment in pathologic myopia pdpm lesions at the inferior border of the patients myopic conus. Degenerative myopia is more severe than other forms of myopia and is associated with retina changes, potentially causing severe vision loss. Peripheral lacquer cracks as an early finding in pathological myopia. Ophthalmic surgery, lasers and imaging retina this study was aimed at reporting a set of complications associated with retinal pigment epithelium rpe humps in high myopia. Other clinical findings associated with pm include posterior staphyloma, lacquer cracks, tessellated fundus, tilted optic disc, and straightened and attenuated vessels. Lacquer cracks are a risk factor for cnv, a severe complication of advanced pathologic myopia. Description high myopia is defined as myopia greater than 6 diopters and an axial length of 26. Myopic cnv often arise from lacquer cracks, but can effectively be treated by pdt and antivegf. Purposelacquer cracks are found in the posterior fundus of 4. Slitlamp biomicroscopy revealed lacquer cracks to be irregular, yellow lines in the deepest portion of the retina. Detection of lacquer cracks can sometimes be difficult especially in eyes with diffuse atrophy. Jun 16, 2012 this article was created to educate students on the basics of degenerative myopia. Caused by stretching of ocular tissue due to axial elongation, but not correlated to length. Lacquer cracks are mechanical breaks in the bruch membraneretinal pigment epithelium rpechoriocapillaris complex owing to excessive axial elongation and represent a hallmark feature of pathologic myopia.
72 598 1282 1338 888 997 1107 116 1244 511 1417 620 1045 337 84 355 686 53 1111 1016 1121 405 325 1015 875 956 831 457 746 1309 943 23 1269 810 200 532 106 1095 1262 837 703 115 1090 1188 1042 498 1170 1201 142 1004